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Millions of healthy men and women with normal to near-normal cholesterol levels may be able to prevent first heart attacks through long-term therapy with the cholesterol-lowering drug lovastatin (Mevacor, Merck & Co.). Preliminary results from the Air Force/Texas Coronary Atherosclerosis Prevention (AFCAPS/TexCAPS) Study show that risk of first cardiac event in this population was reduced by 36 percent.

These findings were reported at the American Heart Association's annual meeting held today in Orlando, Florida.

"The results of our study carry profound implications for all adults who think they are at low risk of a heart attack," said Dr. Antonio Gotto, the Stephen and Suzanne Weiss Dean of Cornell University Medical College and Chairman and spokesman for the AFCAPS/TexCAPS steering committee.

"Even if your LDL or 'bad' cholesterol isn't high, you still may be at risk for heart attack if your HDL or 'good' cholesterol is too low," said Dr. Gotto. "Now we know that treatment with lovastatin can significantly reduce risk of heart attack and other events so people can live healthier lives."

The AFCAPS/TexCAPS trial was the first to determine if treatment with lovastatin to reduce LDL (bad cholesterol) would decrease first coronary events in men and women without heart disease who have an average LDL but a relatively low HDL (good cholesterol) level. The AFCAPS/Tex/CAPS steering committee voted unanimously to end the blinded study early.

Participants took moderate doses of lovastatin, beginning at 20 mg daily; the dose could be titrated upward to 40 mg per day to target an LDL-cholesterol goal of 110 mg/dl or less. Lovastatin reduced total cholesterol by 18.4 percent, reduced LDL cholesterol by 25 percent, and triglycerides by 15 percent. Levels of HDL, or good cholesterol, increased by 6 percent.

The average total cholesterol at baseline was 221 mg/dl, average LDL cholesterol was 150 mg/dl and average HDL cholesterol was 37 mg/dl. No patients had clinical evidence of coronary heart disease; only 22 percent had hypertension and 12 percent were smokers (lower than average for the U.S. population).

"Our study will have profound implications on the way heart disease is diagnosed and treated. We will see many more adults being tested, not only for cholesterol, but for HDL," said Dr. Gotto.

"And if a patient has a low HDL, even though his total cholesterol is only 200 or 220, he should be treated with lovastatin," he added.

The AFCAPS/TexCAPS study, included over one thousand women, which makes it the only primary prevention trial to include women. "And although they are at lower risk for heart attack than men, the female participants reaped the same benefits as men by taking lovastatin," he added.

AFCAPS/TexCAPS was conducted at Wilford Hall U.S.A.F. Medical Center in San Antonio, Texas and the University of North Texas Science Center in Fort Worth. It began in 1990 under a research grant by Merck & Company, Inc., and was scheduled to conclude in 1998. The scientific direction of the trial was provided by a steering committee made up of nine independent medical investigators, led by Dr. Gotto.

Dr. Gotto's research interests include the pathology of atherosclerosis and coronary heart disease. He recently co-authored The New Living Heart—which explains the origin, diagnosis and treatment of cardiovascular disease to the general public.