Physicians' Academy for Cardiovascular Education

WOSCOPS analysis supports LDL-C lowering for primary prevention at high LDL-c without risk assessment

LDL-Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men with Primary Elevations of LDL-Cholesterol Levels of 190 mg/dL or Above: Analyses from the WOSCOPS 5-year Randomised Trial and 20-year Observational Follow-Up

Vallejo-Vaz AJ, Robertson M, Catapano AL, et al. - Circulation 2017; 136:1878-91

Background

Elevations of LDL-C ≥190 mg/dL are associated with a higher risk of atherosclerotic CVD in individuals without CVD [1,2]. Therefore, initiation of lipid-lowering therapy is recommended for individuals with primary elevations of LDL-C ≥190 mg/dL without the need for risk assessment, despite the lack of published randomized trial evidence supporting these recommendations in primary prevention. Furthermore, clinical guidelines have differed on whether to recommend percentage reductions in LDL-C or specific LDL-C levels among such patients [3,4].

In the present analysis of the WOSCOPS study, the CV effects of LDL-C lowering are reported in 5529 individuals with primary elevation of LDL-C ≥190 mg/dL without evidence of vascular disease at baseline [5,6]. Moreover, the relationship between reductions in LDL-C and on-treatment LDL-C levels with subsequent clinical events was evaluated.

In WOSCOPS, 6595 men with a mean age of 55 years were randomised to pravastatin 40 mg once daily or placebo, for a mean follow-up of 4.9 years. Patients were stratified by LDL-C levels at baseline.

Principle endpoints were as follows: CHD as the composite of definite or suspected non-fatal MI plus definite or suspected CHD death and MACE (CV death, non-fatal MI (definite or suspected) and non-fatal stroke).

Main results

Conclusion

Men with LDL-C levels ≥190 mg/dL without atherosclerotic CVD, have a 2-fold higher risk of major CV events than would be predicted with a risk calculator. These results provide evidence for the benefits of LDL-C lowering for the primary prevention of individuals with primary elevations of LDL-C ≥190 mg/dL, which may help reinforce current recommendations for this group of patients.

References

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