JRSM > Volume 97, Number 2 > Pp. 66-71

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Statins for primary prevention: strategic options to save lives and money

James Shepherd FRCPath FMedSci  

Institute of Biochemistry, Royal Infirmary, Glasgow G4 0SF, Scotland, UK

View larger version (19K): [in a new window]   Figure 1. CHD deaths avoided versus plasma cholesterol in the Multiple Risk Factor Intervention Trial. As cholesterol is lowered from 7.8 to 3.9 mmol/L, two-thirds of the total risk reduction is realized by individuals in the highest tertile while only 8% of the total comes to those in the lowest

 

View larger version (11K): [in a new window]   Figure 2. Not all patients respond adequately to statins. Only one-fifth of the WOSCOPS cohort who received pravastatin reached the European Atherosclerosis Society (EAS) target LDL cholesterol of 3.0 mmol/L

 

View larger version (16K): [in a new window]   Figure 3. Even the most potent statins fail to achieve targets. If it is assumed that 10 mg of atorvastatin produces the same LDL cholesterol reduction as 40 mg of pravastatin, and that for each doubling of its dose there is a further 6% fall in LDL cholesterol, then even the highest recommended dose of atorvastatin (80 mg) will fail to bring the entire WOSCOPS cohort to the European LDL target value of 3.0 mmol/l. This figure should be viewed in conjunction with Figure 2

 

View larger version (16K): [in a new window]   Figure 4. Coronary risk reduction in CARE and LIPID. The databases from the CARE (Ref 17) and LIPID (Ref 18) studies were interrogated to determine the benefits of pravastatin (40 mg/day) on fatal and nonfatal myocardial infarction 3.3 years into each study and at their termination

 

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