Application of the National Cholesterol Education Program and joint European treatment criteria and clinical benefit in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)

Aims The Air Force/Texas Coronary Atherosclerosis Prevention Study reported that diet with lovastatin, 20-40 mg daily, reduced the risk for a first co ronary event by 37%. Because only 17% of this cohort would have qualified f or drug therapy according to current U.S. guidelines, we assessed clinical benefit by risk categories. Methods and Results The main outcome measures were event rates of first acu te major coronary events stratified by National Cholesterol Education Progr am and European criteria and target goal. Both those who would and would no t be eligible for drug therapy, according to National Cholesterol Education Program guidelines, benefited from intervention. As expected, drug-eligibl e participants (event rate: lovastatin 1%/year, placebo 1.87%/year [relativ e risk 0.53, 95% confidence interval: 0.33, 0.84]) were at greater absolute risk for acute major coronary events than non-eligible participants (lovas tatin 0.62%/year, placebo 0.93%/year [relative risk 0.67, 95% confidence in terval: 0.51, 0.88]). Similar results were found using European guidelines for coronary risk management. Treatment to a target goal suggested a non-si gnificant trend to greater benefit. Conclusions The consistent relative benefit across risk categories suggests that it may be possible to improve identification of at-risk persons who w ould benefit from primary prevention, and to recommend appropriate goals of such treatment. (C) 2000 The European Society of Cardiology.