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Previous Volume 357:1477-1486 October 11, 2007 Number 15 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Domanski, M. J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The West of Scotland Coronary Prevention Study was a randomized clinical trial comparing pravastatin with placebo in men with hypercholesterolemia who did not have a history of myocardial infarction, with an average follow-up of approximately 5 years. The combined outcome of death from definite coronary heart disease or definite nonfatal myocardial infarction was reduced from 7.9 to 5.5% (P<0.001) in the treatment group. Extended follow-up data were obtained for approximately 10 years after completion of the trial.

Methods For the survivors of the trial, all deaths, hospitalizations and deaths due to coronary events and stroke, and incident cancers and deaths from cancer were tracked with the use of a national computerized record-linkage system. The results were analyzed with time-to-event analyses and use of Cox proportional-hazards models.

Results Five years after the trial ended, 38.7% of the original statin group and 35.2% of the original placebo group were being treated with a statin. In the period approximately 10 years after completion of the trial, the risk of death from coronary heart disease or nonfatal myocardial infarction was 10.3% in the placebo group and 8.6% in the pravastatin group (P=0.02); over the entire follow-up period, the rate was 15.5% in the placebo group and 11.8% in the pravastatin group (P<0.001). Similar percentage reductions were seen in the combined rate of death from coronary heart disease and hospitalization for coronary events for both periods. The rate of death from cardiovascular causes was reduced (P=0.01), as was the rate of death from any cause (P=0.03), over the entire follow-up period. There were no excess deaths from noncardiovascular causes or excess fatal or incident cancers.

Conclusions In this analysis, 5 years of treatment with pravastatin was associated with a significant reduction in coronary events for a subsequent 10 years in men with hypercholesterolemia who did not have a history of myocardial infarction.

Source Information

From the Robertson Centre for Biostatistics (I.F., H.M.) and the Division of Cardiovascular and Medical Sciences (C.J.P., J.S., P.W.M., S.M.C.), University of Glasgow, Glasgow, United Kingdom.

Address reprint requests to Dr. Ford at the Robertson Centre for Biostatistics, Boyd Orr Bldg., University of Glasgow, Glasgow G12 8QQ, United Kingdom.

Full Text of this Article

Related Letters:

Long-Term Follow-up of the West of Scotland Coronary Prevention Study
McEvoy J. W., Margey R., Blake G. J., Tsubokura M., Kami M., DeFilippis A. P., Bansal S., Blumenthal R. S., Ford I., Murray H., Cobbe S. M.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:193-195, Jan 10, 2008. Correspondence

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