New Insights from Landmark Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)
Mar 14, 2000
New data presented this week at the 49th Annual Scientific Session of the American College of Cardiology suggest that current guidelines for treating lipids may need to be refined in generally healthy persons with average low-density lipoprotein cholesterol (LDL-C, the "bad" cholesterol) and below average high-density lipoprotein cholesterol (HDL-C, the "good" cholesterol) levels.
Benefits of Lovastatin in Risk Groups Defined by Framingham Risk Equations
In an abstract discussed by Antonio M. Gotto, Jr., MD, DPhil, Dean of the Weill Medical College of Cornell University, and presented by Lt. Col. John R. Downs, MD, primary investigator of the AFCAPS/TexCAPS, the study's cohort was examined using risk-prediction modeling based on the Framingham Heart Study. Based upon Framingham modeling, the majority of men and women in AFCAPS/TexCAPS were at moderate to high risk for coronary events, despite having no prior history of coronary events. The benefit of lovastatin treatment was consistently observed across multiple subgroups of risk defined by this model.
These results support the rationale for extending current guidelines for treating individuals without coronary disease with lipid-modifying drugs to include not only individuals at higher risk for coronary disease, but also those at more moderate risk. Based on these results and the overall findings of the study, guidelines could be simplified to suggest lipid-modifying drug treatment for any patient without existing coronary disease with the following profile:
- Age (> 45 years for men, > 55 years for women)
- Cholesterol (Total cholesterol > 200 mg/dL and HDL-C < 50 mg/dL)
- Plus One Other Risk Factor for Coronary Disease (such as smoking, hypertension, etc.)
Lovastatin Reduced the Need for Invasive Cardiac Procedures
William Kruyer, MD, presented data on the use of invasive procedures to treat AFCAPS/TexCAPS participants during the course of the study. As previously presented, pre-specified analysis of total coronary revascularizations, a secondary endpoint in the study, reported a 33% reduction in the need for such procedures (p = 0.001). Additional post-hoc analysis of the AFCAPS/TexCAPS database revealed that treatment with lovastatin reduced:
- Total number of invasive cardiac procedures by 26%
- First diagnostic angiography by 22%
- Surgical revascularization (coronary bypass graft or CABG) by 22% and
- Catheter-based first revascularization (primarily PTCA) by 43%.