(Circulation. 2000;101:477.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Relation Between Baseline and On-Treatment Lipid Parameters and First Acute Major Coronary Events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)
From Weill Medical College of Cornell University, New York, NY (A.M.G., J.Y.J.); The Heart and Vascular Institute of Texas, San Antonio, Tex (E.W.); Medical Research Laboratories, Highland Heights, Ky (E.A.S.); Merck & Co, Inc, Blue Bell, Pa (D.R.S., A.L., P.A.B., D.J.W.); University of North Texas Health Science Center, Fort Worth, Tex (M.C., S.W.); Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, Tex (J.R.D.); and University of Pennsylvania (emeritus), Philadelphia, Pa (J.S.d.C.).
Correspondence to Antonio M. Gotto, c/o Jesse Jou, Weill Medical College of Cornell University, 445 E 69th St, Olin Hall Room 205, New York, NY 10021. E-mail amg_editorial{at}mail.med.cornell.edu
Background—The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is the first primary-prevention study in a cohort with average total cholesterol (TC) and LDL cholesterol (LDL-C) and below-average HDL cholesterol (HDL-C). Treatment with lovastatin (20 to 40 mg/d) resulted in a 25% reduction in LDL-C and a 6% increase in HDL-C, as well as a 37% reduction in risk for first acute major coronary event (AMCE), defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. This article describes the relation between baseline and on-treatment lipid and apolipoprotein (apo) parameters and subsequent risk for AMCEs.
Methods and Results—With all available data from the entire 6605-patient cohort, a prespecified Cox backward stepwise regression model identified outcome predictors, and logistic regression models examined the relation between lipid variables and AMCE risk. Baseline LDL-C, HDL-C, and apoB were significant predictors of AMCE; only on-treatment apoB and the ratio of apoB to apoAI were predictive of subsequent risk; on-treatment LDL-C was not. When event rates were examined across tertiles of baseline lipids, a consistent benefit of treatment with lovastatin was observed.
Conclusions—Persons with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification. On-treatment apoB, especially when combined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDL-C of risk for first AMCE.
Key Words: lipids • coronary disease • prevention • risk factors • apolipoproteins
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S. J. Robins, D. Collins, J. T. Wittes, V. Papademetriou, P. C. Deedwania, E. J. Schaefer, J. R. McNamara, M. L. Kashyap, J. M. Hershman, L. F. Wexler, et al. Relation of Gemfibrozil Treatment and Lipid Levels With Major Coronary Events: VA-HIT: A Randomized Controlled Trial JAMA, March 28, 2001; 285(12): 1585 - 1591. [Abstract] [Full Text] [PDF]
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A. von Eckardstein, J.-R. Nofer, and G. Assmann High Density Lipoproteins and Arteriosclerosis : Role of Cholesterol Efflux and Reverse Cholesterol Transport Arterioscler Thromb Vasc Biol, January 1, 2001; 21(1): 13 - 27. [Abstract] [Full Text] [PDF]
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J. E. R. van Lennep, H. T. Westerveld, H. W. O. R. van Lennep, A. H. Zwinderman, D. W. Erkelens, and E. E. van der Wall Apolipoprotein Concentrations During Treatment and Recurrent Coronary Artery Disease Events Arterioscler Thromb Vasc Biol, November 1, 2000; 20(11): 2408 - 2413. [Abstract] [Full Text] [PDF]
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F. M. Sacks, A. M. Tonkin, J. Shepherd, E. Braunwald, S. Cobbe, C. M. Hawkins, A. Keech, C. Packard, J. Simes, R. Byington, et al. Effect of Pravastatin on Coronary Disease Events in Subgroups Defined by Coronary Risk Factors : The Prospective Pravastatin Pooling Project Circulation, October 17, 2000; 102(16): 1893 - 1900. [Abstract] [Full Text] [PDF]
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T. A. Jacobson "The Lower the Better" in Hypercholesterolemia Therapy: A Reliable Clinical Guideline? Ann Intern Med, October 3, 2000; 133(7): 549 - 554. [Abstract] [Full Text] [PDF]
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R. J. Simes, I. C. Marschner, D. Hunt, D. Colquhoun, D. Sullivan, R. A.H. Stewart, W. Hague, A. Keech, P. Thompson, H. White, et al. Relationship Between Lipid Levels and Clinical Outcomes in the Long-Term Intervention With Pravastatin in Ischemic Disease (LIPID) Trial: To What Extent Is the Reduction in Coronary Events With Pravastatin Explained by On-Study Lipid Levels? Circulation, March 12, 2002; 105(10): 1162 - 1169. [Abstract] [Full Text] [PDF]
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P. M. Ridker, J. Shih, T. J. Cook, M. Clearfield, J. R. Downs, A. D. Pradhan, S. E. Weis, A. M. Gotto Jr, and for the Air Force/Texas Coronary Atherosclerosis P Plasma Homocysteine Concentration, Statin Therapy, and the Risk of First Acute Coronary Events Circulation, April 16, 2002; 105(15): 1776 - 1779. [Abstract] [Full Text] [PDF]
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