Landmark lipid-lowering trials in the primary prevention of cardiovascular disease

Abstract

Although atherosclerotic cardiovascular disease (CVD) is the most common cause of morbidity and mortality in the world, the long disease latency affords ample opportunity for preventive care. Indeed, lifelong exposure to atherogenic apoliprotein B-containing lipoproteins has consistently been shown to increase the cumulative risk of suffering a CVD event, including myocardial infarction, stroke, and symptomatic peripheral arterial disease. Over the past 25 years, lipid-lowering therapies have been developed that are proven to not only lower cholesterol, but also to decrease adverse CVD events and CVD mortality. This review will highlight several key clinical trials encompassing several classes of lipid-lowering medications that have provided clinicians with an evidence-based framework for managing their patients' cardiovascular risk.

Figure 1

LDL‐C reduction in landmark statin primary prevention trials. Abbreviations: AFCAPS/TexCAPS, Air Force/Texas Coronary Atherosclerosis Prevention Study; ASCOT‐LLA, Anglo‐Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm; JUPITER, Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin; LDL‐C, low‐density lipoprotein cholesterol; LDL‐P, placebo arm low‐density lipoprotein cholesterol; LDL‐S, statin arm low‐density lipoprotein cholesterol; MEGA, Primary Prevention of Cardiovascular Disease with Pravastatin in Japan; WOSCOPS, West of Scotland Coronary Prevention Study.

Figure 2

Event rate in placebo vs statin arms in landmark statin primary prevention trials. Abbreviations: AFCAPS/TexCAPS‐P/AFCAPS/TexCAPS‐S, Air Force/Texas Coronary Atherosclerosis Prevention Study Placebo/Statin; ASCOT‐LLA‐P/ASCOT‐LLA‐S, Anglo‐Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm Placebo/Statin; JUPITER‐P/JUPITER‐S, Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin Placebo/Statin; LDL‐C, low‐density lipoprotein cholesterol; LDL‐P, placebo arm low‐density lipoprotein cholesterol; LDL‐S, statin arm low‐density lipoprotein cholesterol; MEGA‐P/MEGA‐S, Primary Prevention of Cardiovascular Disease with Pravastatin in Japan Placebo/Statin; WOSCOPS‐P/WOSCOPS‐S, West of Scotland Coronary Prevention Study Placebo/Statin.