Page 848 - Cardiac Nursing

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824 PA R T V / Health Promotion and Disease Prevention
Table 36-1 ■ SELECTED, RANDOMIZED, CLINICAL TRIALS USING STATIN THERAPY TO LOWER CHOLESTEROL
Average
Number of Age Lipids Length of Mean Lipid
Trial Patients (years) (mean, mg/dL) Follow-up Reduction Outcomes
Primary Prevention
West of Scotland 6,595 men 45–64 TC: 272 4.9 years TC: T 20% Nonfatal MI and
(WOSCOPS)* LDL: 192 LDL: T 26% CVD death: T 31%
AFCAPS/TEXCAPS † 5,608 men TC: 221 5.2 years TC: T 18% Major coronary events
g
g
997 women LDL: 150 LDL: T 25% (MI, unstable angina, or sudden
cardiac death: T 37%)
Primary and Secondary Prevention
Heart Protection 15,454 men 40–80 TC: 228 5.0 years LDL T 37 mg/dL All cause mortality T 13%,
Study ‡ 5,082 women (52% 65) LDL: 131 ‡‡ major vascular events T24%
Coronary death rats T 27%,
nonfatal/fatal stroke T 25%
Nonfatal MI and coronary
death T 27%.
Prospective Study of 2,804 men 70–82 TC: 150–350 3.2 years LDL: T 34% Composite of: coronary death,
Pravastatin in the 3,000 women nonfatal MI, fatal or nonfatal
Elderly at Risk § stroke T 24%
Anglo-Scandinavian 10,350 40–79 LDL: 132 3.3 (stopped LDL T 29% Total cardiovascular
Cardiac Outcomes 81% male early due to events T 21%
Trial-Lipid benefit) Total coronary events T 29%
Lowering Arm || Total fatal and nonfatal
stroke T 7%
Secondary Prevention
Scandinavian 3,617 men 35–70 TC 5.4 years TC T 28% CHD deaths: T 42%
Simvastatin 427 women LDL: 188 LDL: T 38% Nonfatal MI and CVD
Survival Study (4S) ¶ death T 37%
CARE # 4,159 Average 59 LDL: 139 3 years LDL: T 27% Major coronary events T 25%
Coronary mortality T 24%
Total mortality T 9%
LIPID** 9,014 31–75 LDL: 150 61 years LDL: T 25% Major coronary events T 29%
Coronary mortality T 24%
Total mortality T 23%
Pravastatin or 4,162 18 TC: 240 mg/dL 24 months LDL: T 22% Composite death from any
Atorvastatin Mean LDL: 106 Pravastatin cause, MI, hospitalization
Evaluation and T 51% from unstable angina,
Infection— Atorvastatin revascularization, or stroke
Thrombolysis in MI †† T 16%
TC, total cholesterol; LDL, low density lipoprotein
*WOSCOPS: Shepherd, J., Cobbe, S. M., Ford, I., et al., for the West of Scotland Coronary Prevention Study Group. (1995). Prevention of coronary heart disease with pravastatin in
men with hypercholesterolemia. New England Journal of Medicine, 333, 1301–1307.
† AFCAPS/TEXCAPS: Downs, J. R., Clearfield, M., Weis, S., et al., for the AFCAPS/TexCAPS Research Group. (1998). Primary prevention of acute coronary events with lovastatin
in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS. JAMA, 279, 1615–1622.9 9
‡ HPS: Heart Protection Study Collaborative Group. (2002). Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: A randomised placebo-
controlled trial. Lancet, 360, 7Y22.0 0
§ Shepherd, J., Blauw, G. J., Murphy, M. B., et al., PROSPER study group. (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): A randomised controlled
trial. PROspective Study of Pravastatin in the Elderly at Risk. Lancet, 360, 1623–1630.0 0
|| Sever, P. S., Dahlof, B., Poulter, N. R., et al., ASCOT investigators. (2003). Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or
lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): A multicentre randomised controlled trial.
Lancet, 361, 1149–1158.
¶ 4S: Scandinavian Simvastatin Survival Study Group. (1994). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: The Scandinavian Simvastatin
Survival Study (4S). Lancet, 344, 1383–1389.4 4
# CARE: Sacks, F. M., Pfeffer, M. A., Moye, L. A., et al., for the Cholesterol and Recurrent Events Trial Investigators. (1996). The effect of pravastatin on coronary events after
myocardial infarction in patients with average cholesterol levels. New England Journal of Medicine, 335, 1001–1009.
5
5
**LIPID: Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. (1998). Prevention of cardiovascular events and death with pravastatin in patients with
coronary heart disease and a broad range of initial cholesterol levels. New England Journal of Medicine, 339, 1349–1357.9 9
†† Cannon, C. P., Braunwald, E., McCabe, C. H., et al., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators.
(2004). Intensive versus moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 350, 1495–1504.
0
0
‡‡ Serum lipids were determined by direct LDL measurement method as baseline samples were nonfasting. If calculated by Friedewald (as in other trials) LDL would be 15%
higher.
been identified: apo A-I, apo A-II, apo B-100, apo B-48, apo C- transfer protein [CETP]) and the function of cell receptors, in-
I, apo C-II, apo C-III, apo E2, apo E3, apo E4, and lipopro- cluding the LDL and chylomicron remnant receptor, are now
tein(a), or Lp(a). In addition, the actions of several lipoprotein- established. These advances permit an understanding of lipid
processing enzymes (lipoprotein lipase [LPL], hepatic lipase metabolism, as well as the abnormalities leading to elevated
[HL], lecithin cholesterol acyltransferase, and cholesteryl ester blood cholesterol.