Follow-up on primary prevention trials

Recent primary prevention trials demonstrated that cardiovascular morbidity and mortality benefits are not accompanied by adverse effects on overall m ortality and morbidity in cohorts representing plasma cholesterol concentra tions observed in the bulk of coronary artery disease. During the past year , further analyses of the West of Scotland Coronary Prevention Study have i ndicated that benefit requires a 25% reduction of LDL cholesterol and that such treatment is not very expensive when focussed on selected high-risk in dividuals. The Air Force/Texas Coronary Artery Prevention Study indicated t hat benefit is seen in individuals with even lower plasma lipid concentrati on. Although current treatment with lifestyle and lipid modifying drug mana gement is successful in primary prevention, the unpredictable nature of cor onary artery disease and the cost of drugs mitigate against direct applicat ion of drug management in persons with relatively low risk, but selective t reatment should be undertaken in very high-risk settings. Future studies ne ed to examine more specific at risk cohorts, test better targeted lipoprote in modification, test more risk factors and also examine whether changes in vascular function or markers of inflammation will predict a better outcome . Curr Opin Lipidol 9:551-556. (C) 1998 Lippincott Williams & Wilkins.