Lipid Lowering Therapy in Primary and Secondary Prevention: Insights from LIPID and WOSCOPS

Clinical trials have demonstrated that inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase (statins) greatly reduce cardiovascularrelated morbidity and mortality in patients with and without coronary artery disease. The recently presented landmark Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial suggests that even patients with average cholesterol levels may benefit from pravastatin therapy. There is also important new information to suggest that the benefits of pravastatin use in the West of Scotland Coronary Prevention Study (WOSCOPS) and Cholesterol and Recurrent Events (CARE) trials may be effected by more than a simple lowering of circulating LDL cholesterol levels. The LIPID trial, the largest secondary prevention trial with a statin, examined the role of low density lipoprotein (LDL) cholesterol in reducing coronary events. Design and baseline data were presented at a satellite symposium on November 9th, while the final (preliminary) results were presented for the first time on November 12, 1997 There is now overwhelming evidence from several largescale clinical trials that therapy with this group of agents leads to less progression and more regression of pre-existing coronary atherosclerotic lesions. 1 Evidence from these trials also suggests fewer subsequent clinical coronary heart disease events among patients with clinically manifest disease. 2-4