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By Scott M. Grundy

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Extra resources for Cholesterol-Lowering Therapy: Evaluation of Clinical Trial Evidence

Example text

In the POSCH study, LDL cholesterol levels fell by 38% in patients receiving the ileal bypass. Patients who underwent the ileal bypass operation experienced a 35% reduction in major coronary events, a marked reduction in need for coronary procedures, and a 35% reduction in coronary deaths. Moreover, there was a strong trend toward a reduction in coronary mortality and total mortality. Among earlier secondary prevention 16 Grundy trials, POSCH provided the strongest evidence for benefit from cholesterol-lowering therapy.

Effect of cholesterol intervention was not 18 Grundy uniform in all categories. For example, a trend toward a decrease in total mortality appeared to be greater in secondary than in primary prevention trials. Other meta-analyses were subsequently carried out. In 1992, Ravnskov (55) reported a combined analysis of all clinical trials of cholesterol-lowering therapy. He found that in 22 controlled, cholesterol-lowering trials the CHD mortality and total mortality were not significantly reduced by treatment.

These trials thus amplify secondary prevention trials by confirming that cholesterol lowering with statins substantially reduces CHD risk. The efficacy and safety of statins in primary prevention studies raises an important question: Who is an appropriate patient for statin therapy? This question is intimately bound with the definition of the high-risk state. Recent statin trials support the concept that aggressive cholesterol-lowering therapy is appropriate for patients whose short-term risk for CHD is high.

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Cholesterol-Lowering Therapy: Evaluation of Clinical Trial Evidence by Scott M. Grundy


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