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Lipid Lowering for Primary Prevention: Still Not for Everyone

The role of lipid-lowering agents is well established for people with known coronary artery disease (CAD); in patients without known CAD, the indications for drug therapy are less clear. U.S. investigators performed a meta-analysis involving 4 primary prevention trials. Participants had a low-to-moderate risk for coronary events: in the placebo groups of the 4 trials, the rates of CAD events ranged from 3 percent to 10 percent during 5 to 7 years of follow-up.

Drug treatment significantly reduced the risk for CAD events (OR, 0.70), but the overall risk for death was not significantly affected (OR, 0.94). In an analysis limited to trials in which statins were used, both these risks were slightly lower (OR, 0.65 and 0.89, respectively), but the difference in mortality was still not significant.

Comment: For people with a low-to-moderate risk for coronary events, lipid-lowering therapy reduced the probability of such events but did not reduce overall mortality risk. The authors postulate that longer follow-up might reveal a mortality benefit, but it is also possible that starting lipid-lowering therapy could wait until the absolute risk of an event is higher. An accompanying editorial reminds us that many people who could benefit from such therapy still aren't getting it, and this gap is where we should be focusing our attention.

— KI Marton

Published in Journal Watch General Medicine November 14, 2000

Citation(s):

Pignone M et al. Use of lipid lowering drugs for primary prevention of coronary heart disease: Meta-analysis of randomised trials. BMJ 2000 Oct 21 321 983-986.

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• Medline abstract (Free)

Hulley SB et al. Statins: Underused by those who would benefit. BMJ 2000 Oct 21 321 971-972.

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• Medline abstract (Free)