Prevention of heart disease: is LDL reduction the outcome of choice? No, there is more.
The West of Scotland Coronary Prevention Study (WOSCOPS), a placebo-controlled 5-year cohort study, demonstrated that the use of pravastatin decreased low density lipoprotein (LDL) levels and associated risk of myocardial infarction. The rate of occurrence of coronary events, however, was similar across the four lowest quintiles of LDL reduction (23-41% reductions in mean LDL levels). The relationship between reduction of LDL and the reduction of risk was not linear. Further analysis indicated that even in overlap groups where patients exhibited equivalent mean LDL levels on treatment, pravastatin treatment was associated with less risk of occurrence of coronary events than placebo treatment. These results suggest that while LDL level does serve as a predictor of the risk of coronary events, other factors exist that should be considered and investigated further.
Shepherd
J
J
Institute of Biochemistry, Royal Infirmary, Glasgow, UK.
Park
J S
JS