BASE-LINE RISK-FACTORS AND THEIR ASSOCIATION WITH OUTCOME IN THE WESTOF SCOTLAND CORONARY PREVENTION STUDY

The West of Scotland Coronary Prevention Study recently demonstrated t he benefits of pravastatin therapy in the prevention of coronary heart disease events in middle-aged hypercholesterolemic men without prior myocardial infarction. We present an analysis of the influence of base line risk factors on coronary events and total mortality in the trial, and their interaction with therapy, using the Cox proportional hazard s model. The multivariate predictors of fatal or nonfatal coronary eve nts were treatment allocation (pravastatin or placebo), current smokin g, diabetes mellitus, nitrate consumption, minor electrocardiographic abnormalities, angina pectoris, family history of premature coronary d eath, widowhood, blood pressure, and total cholesterol/high density li poprotein cholesterol ratio. Independent of other risk factors, pravas tatin reduced the risk of definite coronary heart disease death or non fatal myocardial infarction by 32% (95% confidence interval 17 to 44, p = 0.0001), definite or suspected coronary heart disease death by 35% (3 to 56, p = 0.035), cardiovascular death by 33% (4 to 53, p = 0.027 ), coronary revascularization procedures by 38% (11 to 56, p = 0.009), and all-cause mortality by 24% (2 to 41, p = 0.037). The 5-year risk of fatal or nonfatal myocardial infarction, calculated using the predi ctors identified in the Cox analysis, ranged from <4.4% in the lowest quartile of risk to >9.6% in the highest quartile. The proportional be nefit achieved by pravastatin was independent of other risk factors; h ence, the absolute benefit of therapy was greatest in subjects with th e highest baseline risk. Such subjects can be identified easily in the population and deserve high priority for treatment. (C) 1997 by Excer pta Medica, Inc.