Abstract
The Scandinavian Simvastatin Survival Study (4S) 1 Scandinavian Simvastatin Survival Study Group Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344: 1383-1389 Summary PubMed Scopus (11230) Google Scholar and West of Scotland Coronary Prevention Study (WOSCOPS) 2 Shepherd J Cobbe SM Ford I et al. for the West of Scotland Coronary Prevention Study Group Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995; 333: 1301-1307 Crossref PubMed Scopus (7448) Google Scholar showed that the benefit of treatment with inhibitors of hydroxymethyl-glutaryl-coA-reductase (statins) in preventing major coronary heart disease (CHD) events substantially outweighs any harm when serum cholesterol averages 5·5 mmol/L or higher1 and when the risk of CHD events (myocardial infarction or coronary death) is 1·5% per year or higher. 2 Shepherd J Cobbe SM Ford I et al. for the West of Scotland Coronary Prevention Study Group Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995; 333: 1301-1307 Crossref PubMed Scopus (7448) Google Scholar The accepted priority for statin treatment is secondary prevention in patients who already have coronary disease or other clinically overt atherosclerotic disease and serum cholesterol of 5·5 mmol/L, or higher, since these patients have a high risk of CHD events (3-6% per year). 3 Haq IU, Ramsay LE, Pickin DM, Yeo WW, Jackson PR. Payne JN. Lipid-lowering for prevention of coronary heart disease: what policy now? Clin Sci (in press). Google Scholar , 4 Haq IU Jackson PR Yeo WW Ramsay LE Sheffield risk and treatment table for cholesterol lowering for primary prevention of coronary heart disease. Lancet. 1995; 346: 1467-1471 Summary PubMed Google Scholar We have estimated that 4·8% of the UK population aged 35-69 years may be candidates for secondary prevention. 3 Haq IU, Ramsay LE, Pickin DM, Yeo WW, Jackson PR. Payne JN. Lipid-lowering for prevention of coronary heart disease: what policy now? Clin Sci (in press). Google Scholar
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