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Original Article Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia James Shepherd, M.D., Stuart M. Cobbe, M.D., Ian Ford, Ph.D., Christopher G. Isles, M.D., A. Ross Lorimer, M.D., Peter W. Macfarlane, Ph.D., James H. McKillop, M.D., and Christopher J. Packard, D.Sc., for the West of Scotland Coronary Prevention Study Group N Engl J Med 1995; 333:1301-1308 DOI: 10.1056/NEJM32001.
Results Pravastatin lowered plasma cholesterol levels by 20 percent and low-density lipoprotein cholesterol levels by 26 percent, whereas there was no change with placebo. There were 248 definite coronary events (specified as nonfatal myocardial infarction or death from coronary heart disease) in the placebo group, and 174 in the pravastatin group (relative reduction in risk with pravastatin, 31 percent; 95 percent confidence interval, 17 to 43 percent; P. Earlier trials of lipid-lowering drugs in the primary prevention of coronary heart disease have demonstrated that lowering cholesterol levels in middle-aged men with hypercholesterolemia reduces the incidence of myocardial infarction. However, these studies, because of their design and low rates of observed events, were unable to show a clear effect of therapy on the risk of death from coronary heart disease or death from any cause. A meta-analysis of the trials provided support for the likelihood that therapy lowered the risk of death from coronary heart disease, but it also aroused concern that the risk of death from noncardiovascular causes might be increased by treatment. Whether this latter association was due to chance, to the reduction in cholesterol itself, or to an adverse effect of the drugs is not clear. Recently, a new class of lipid-lowering drug, the 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors, has been introduced into clinical practice.
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