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1、PreventionofCoronaryHeartDiseasewithPravastatininMenwithHypercholesterolemia JamesShepherd M D StuartM Cobbe M D IanFord Ph D ChristopherG Isles M D A RossLorimer M D PeterW Macfarlane Ph D JamesH McKillop M D andChristopherJ Packard D Sc fortheWestofScotlandCoronaryPreventionStudyGroup NEnglJMed199
2、5 333 1301 7 Background Thisdouble blindstudywasdesignedtodeterminewhethertheadministrationofpravastatintomenwithhypercholesterolemiaandnohistoryofmyocardialinfarctionreducedthecombinedincidenceofnonfatalmyocardialinfarctionanddeathfromcoronaryheartdisease JamesShepherd etal NEnglJMed1995 333 1301 7
3、 WestofScotlandCoronaryPreventionStudyGroup WOS Randomized double blind placebocontrolled6595men 45to64yearsofageAveragefollow upof4 9years seenat3monthintervals Pravastatin 40mgeachevening vs placebo JamesShepherd etal NEnglJMed1995 333 1301 7 WOSBaselineCharacteristics Meanlipidlevels TC 272mg dLL
4、DL 192mg dLHDL 44mg dLTrigs 162 164mg dL5 ofpatientswithangina3 ofpatientswithclaudication8 ofpatientswithabnormalEKG44 currentsmokers 34 ex smokers JamesShepherd etal NEnglJMed1995 333 1301 7 WOSCOPS HighRiskPrimaryPrevention RiskFactors 1riskfactor 100 2riskfactors 44 3riskfactors Familyhistory Cu
5、rrentCHD 5 JamesShepherd etal NEnglJMed1995 333 1301 7 Endpoints PrimaryNon fatalMIorcoronaryheartdiseasedeathasafirsteventSecondaryNon fatalMICoronaryheartdiseasedeath JamesShepherd etal NEnglJMed1995 333 1301 7 OtherEndpoints CardiovascularmortalityTotalmortalityCoronaryrevascularizationprocedures
6、 JamesShepherd etal NEnglJMed1995 333 1301 7 WOSReductioninLipids Pravastatinreducedlipidlevelsby 20 reductioninTC26 reductioninLDL12 reductioninTrigs5 increaseinHDL Dataanalyzedaccordingtothetreatmentactuallyreceivednotaccordingtotheintention to treatprinciple JamesShepherd etal NEnglJMed1995 333 1
7、301 7 EffectsofPravastatinTherapyonPlasmaLDLCholesterolLevels JamesShepherd etal NEnglJMed1995 333 1301 7 pravastatin intention to treat pravastatin actualtreatment placebo actualtreatment placebo intention to treat NonfatalMIorCHDDeath PrimaryEndpoint 31 RiskReduction P 0 0001 JamesShepherd etal NE
8、nglJMed1995 333 1301 7 Non FatalMI SecondaryEndpoint 31 RiskReduction P 0 0005 JamesShepherd etal NEnglJMed1995 333 1301 7 CHDDeath SecondaryEndpoint 28 RiskReduction P 0 13 JamesShepherd etal NEnglJMed1995 333 1301 7 CardiovascularDeath 32 RiskReduction P 0 033 JamesShepherd etal NEnglJMed1995 333
9、1301 7 CoronaryInterventions InterventionPlaceboPravastatinRisk n 3293 n 3302 Reductionsp valueCoronaryAngiography1289031 0 007PTCA CABG805137 0 009 JamesShepherd etal NEnglJMed1995 333 1301 7 TotalMortality P 0 051 22 RiskReduction JamesShepherd etal NEnglJMed1995 333 1301 7 WOSResults ClinicalEven
10、ts JamesShepherd etal NEnglJMed1995 333 1301 7 WOSConclusions Treatmentwithpravastatinsignificantlyreducedtheincidenceofmyocardialinfarctionanddeathfromcardiovascularcauseswithoutadverselyaffectingtheriskofdeathfromnoncardiovascularcausesinmenwithmoderatehypercholesterolemiaandnohistoryofmyocardialinfarction JamesShepherd etal NEnglJMed1995 333 1301 7 ProjectedBenefits Treatmentof1000hypercholesterolemicmiddleagedmenwithpravastatinforfiveyearswillavoid 14coronaryangiograms8revascularizationproceduresAndavoid 20nonfatalMIs7CHDdeaths2additionaldeaths JamesShepherd etal NEnglJMed1995 333 1301 7
