title: Long-Term Safety and Efficacy of Lowering Low-Density Lipoprotein Cholesterol With Statin Therapy: 20-Year Follow-Up of West of Scotland Coronary Prevention Study.
abstract: BACKGROUND
  Extended follow-up of statin-based low-density lipoprotein cholesterol lowering trials improves the understanding of statin safety and efficacy. Examining cumulative cardiovascular events (total burden of disease) gives a better appreciation of the clinical value of statins. This article evaluates the long-term impact of therapy on mortality and cumulative morbidity in a high-risk cohort of men.
  
  
  RESULTS
  The West of Scotland Coronary Prevention Study was a primary prevention trial in 45- to 64-year-old men with high low-density lipoprotein cholesterol. A total of 6595 men were randomized to receive pravastatin 40 mg once daily or placebo for an average of 4.9 years. Subsequent linkage to electronic health records permitted analysis of major incident events over 20 years. Post trial statin use was recorded for 5 years after the trial but not for the last 10 years. Men allocated to pravastatin had reduced all-cause mortality (hazard ratio, 0.87; 95% confidence interval, 0.80-0.94; P=0.0007), attributable mainly to a 21% decrease in cardiovascular death (hazard ratio, 0.79; 95% confidence interval, 0.69-0.90; P=0.0004). There was no difference in noncardiovascular or cancer death rates between groups. Cumulative hospitalization event rates were lower in the statin-treated arm: by 18% for any coronary event (P=0.002), by 24% for myocardial infarction (P=0.01), and by 35% for heart failure (P=0.002). There were no significant differences between groups in hospitalization for noncardiovascular causes.
  
  
  CONCLUSIONS
  Statin treatment for 5 years was associated with a legacy benefit, with improved survival and a substantial reduction in cardiovascular disease outcomes over a 20-year period, supporting the wider adoption of primary prevention strategies.
authors: From Robertson Centre for Biostatistics (I.F., H.M., C.M.) and College of Medical, Veterinary, and Life Sciences (C.J.P.), University of Glasgow, UK.
authors: Ian
authors: I
authors: Ford
authors: From Robertson Centre for Biostatistics (I.F., H.M., C.M.) and College of Medical, Veterinary, and Life Sciences (C.J.P.), University of Glasgow, UK.
authors: Heather
authors: H
authors: Murray
authors: From Robertson Centre for Biostatistics (I.F., H.M., C.M.) and College of Medical, Veterinary, and Life Sciences (C.J.P.), University of Glasgow, UK. colin.mccowan@glasgow.ac.uk.
authors: Colin
authors: C
authors: McCowan
authors: From Robertson Centre for Biostatistics (I.F., H.M., C.M.) and College of Medical, Veterinary, and Life Sciences (C.J.P.), University of Glasgow, UK.
authors: Chris J
authors: CJ
authors: Packard
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood*; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000401:mortality; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality; D017035:Pravastatin / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin
keywords: clinical trial [publication type]; coronary disease; heart failure; primary prevention; safety