[Practical clinical implications of megastudies for primary prevention]

The results of different meta-analyses conducted in primary prevention have shown an insignificant difference in total mortality or coronary heart disease (CHD) mortality; and only two studies have shown differences in the incidence of CHD. The WOS study, the first study in primary prevention done with statines, observed a 20% reduction in the total cholesterol, a relative risk reduction of 31%, an absolute risk reduction of 2.4% and the number of patients who needed to be treated, to prevent coronary disease during a five year period, was 42. Subgroup analyses showed a greater benefit for high risk patients: smokers and those with peripheral vascular disease. This is why the utilization of a cardiovascular risk estimation, instead of isolated cholesterol levels or other risk factors, is currently recommended. However, it is important to bear in mind that the results of the WOS study cannot be easily extrapolated to Spain because the rates of CHD are much lower here than the ones observed in Scotland. Promotion of treatment of high risk patients with statines must be accompained by a promotion of a healthy lifestyle at both the individual and the community level.