Primary prevention of coronary heart disease with drug therapy. Safety and total mortality issues

Abstract

The Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT) 1,2 was a landmark clinical trial that showed that lowering of the serum cholesterol level by cholestyramine therapy significantly decreased the risk for coronary heart disease (CHD). This trial provided the critical proof for the cholesterol-CHD hypothesis and, thereby, made possible the initiation of the National Cholesterol Education Program. A reduction in CHD rates by cholestyramine therapy was not accompanied by demonstrable serious side effects during the 7-year study period. However, in spite of a reduction in both new-onset CHD and deaths from CHD by cholestyramine treatment, there was not a statistically significant decrease in total mortality; this was because an apparent increase in trauma mortality offset the decrease in CHD deaths. The apparent increase in trauma mortality, it must be noted, was not statistically significant. Cholestyramine therapy in this trial also did not significantly predispose to tumor formation. Although total