Application of the National Cholesterol Education Program and joint European treatment criteria and clinical benefit in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS).
OBJECTIVE
The Air Force/Texas Coronary Atherosclerosis Prevention Study reported that diet with lovastatin, 20-40 mg daily, reduced the risk for a first coronary event by 37%. Because only 17% of this cohort would have qualified for drug therapy according to current U.S. guidelines, we assessed clinical benefit by risk categories.


RESULTS
The main outcome measures were event rates of first acute major coronary events stratified by National Cholesterol Education Program and European criteria and target goal. Both those who would and would not be eligible for drug therapy, according to National Cholesterol Education Program guidelines, benefited from intervention. As expected, drug-eligible participants (event rate: lovastatin 1%/year, placebo 1.87%/year [relative risk 0.53, 95% confidence interval: 0.33, 0.84]) were at greater absolute risk for acute major coronary events than non-eligible participants (lovastatin 0.62%/year, placebo 0.93%/year [relative risk 0.67, 95% confidence interval: 0.51, 0.88]). Similar results were found using European guidelines for coronary risk management. Treatment to a target goal suggested a non-significant trend to greater benefit.


CONCLUSIONS
The consistent relative benefit across risk categories suggests that it may be possible to improve identification of at-risk persons who would benefit from primary prevention, and to recommend appropriate goals of such treatment.
Gotto
A M
AM
Weill Medical College of Cornell University, New York, New York 10021, USA.
Whitney
E
E
Stein
E A
EA
Shapiro
D R
DR
Clearfield
M
M
Weis
S
S
Jou
J Y
JY
Langendörfer
A
A
Beere
P A
PA
Watson
D J
DJ
Downs
J R
JR
de Cani
J S
JS
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015994:Incidence; D008148:Lovastatin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000379:methods*; D013781:Texas / Q000453:epidemiology
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D008148:Lovastatin