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Tomorrow's world: atherosclerosis in the year 2000
1Institute of Biochemistry, Royal Infirmary, Glasgow, UK.
Insights
Pravastatin significantly reduced heart attacks and cardiovascular deaths in middle-aged men. This study highlights statins
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Atherosclerosis, driven by lifestyle, involves lipid accumulation and inflammation in artery walls, leading to serious cardiovascular events.
- Lipid-lowering agents, such as statins (HMG-CoA reductase inhibitors), are crucial for managing atherosclerosis by inhibiting cholesterol synthesis.
Purpose of the Study:
- To evaluate the efficacy of pravastatin in preventing cardiovascular events in middle-aged men.
- To compare the effects of pravastatin with placebo in a large-scale prospective study.
Main Methods:
- The West of Scotland Coronary Prevention Study (WOSCOPS) was a prospective, randomized trial involving 6595 middle-aged men.
- Participants received either pravastatin or a placebo for 5 years.
Main Results:
- Pravastatin reduced the rate of fatal or non-fatal myocardial infarction by one-third.
- Cardiovascular deaths decreased by one-third, and overall mortality by 22% in the pravastatin group compared to placebo.
- Results were compared with the US-CARE study, discussing relative and absolute risk reduction.
Conclusions:
- Pravastatin demonstrates significant efficacy in reducing major cardiovascular events and overall mortality.
- Targeting high-risk individuals with lipid-lowering drugs like pravastatin is a rational, cost-effective strategy for cardiovascular risk reduction.
Abstract:
Atherosclerosis is an increasing problem, largely due to lifestyle changes. Lipid accumulates in artery walls throughout life, and infiltration into the subintimal space of cholesterol and cholesterol esters and of inflammatory cells can lead to narrowing, clotting, thrombosis and death. Lipid-lowering agents, particularly statins [(3-hydroxy-3-methylglutarate coenzyme A (HMG-CoA) reductase inhibitors] represent one important approach to treatment. They work by blocking the conversion of 3-hydroxy-3-methylglutarate into mevalonate, a precursor of cholesterol. The West Of Scotland Coronary Prevention Study (WOSCOPS) was a large prospective randomised study comparing the effects of pravastatin versus that of placebo in 6595 middle-aged men. In the pravastatin group the rate of fatal or non-fatal myocardial infarction was reduced by one-third over 5 years, the rate of cardiovascular deaths by one-third, and overall deaths by 22% relative to the placebo group. Implications of the results are considered and the results of the US-CARE study are compared. Discussion of relative and absolute risk, and continuous and discrete risk factors leads to the formulation of rational cost/beneficial strategies for decreasing cardiovascular risk by targeting high-risk individuals with lipid-lowering drugs.