Applicability of cholesterol-lowering primary prevention trials to a general population - The Framingham heart study

Background: Four large trials have shown cholesterol-reduction therapy to b e effective for primary prevention of coronary heart disease (CHD). Methods: To determine the generalizability of these trials to a community-b ased sample, we compared the total cholesterol and high-density lipoprotein cholesterol (HDL-C) distributions of patients in the 4 trials with. those of Framingham Heart Study subjects. Lipid profiles that have not been studi ed were identified. Twelve-year rates of incident CHD were compared between subjects who met eligibility criteria and those who did not. Results: The Framingham sample included 2498 men and 2870 women aged 30 to 74 years. Among Framingham men, 23.4% to 42.0% met eligibility criteria for each of tile 4 trials based on their lipid levels; 60.2% met eligibility c riteria for at least 1 trial. For the 1 trial that included women, 20.2% of Framingham women met eligibility criteria. In general, subjects with desir able total cholesterol levels and lower HDL-C levels and subjects with aver age total cholesterol levels and average to higher HDL-C levels have not be en included in these trials. Among subjects who developed incident CHD duri ng follow-up, 25.1% of men and 66.2% of women would not have been eligible for any trial. Most ineligible subjects who developed CHD had isolated hype rtriglyceridemia (>2.25 mmol/L [>200 mg/dL]). Conclusions: In our sample, 40% of men and 80% of women had lipid profiles that have not been studied in large trials to date. We observed a large num ber of CHD events in "ineligible" subjects in whom hypertriglyceridemia was common. Further studies are needed to define the role of lipid-lowering th erapy vs other strategies for primary prevention in the general population.