a) The West of Scotland Coronary Prevention Study (WOSCOPS): The study randomized healthy men between the ages of 45 and 64 years with TC levels higher that 252 mg/dL and LDL cholesterol levels of 174 to 232 mg/dL to pravastatin (40mg/day) or to placebo for an average of 5 years and demonstrated a 31 per cent relative reduction in the incidence of nonfatal MI or CAD death.
b) The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS): AFCAPS/TexCAPS capitalized on the increased risk among healthy persons with low HDL levels (mean, 36mg/dL) and high TC levels (mean, 221 mg/dL). Therapy with the cholesterol-lowering drug lovastatin reduced by 36 per cent the risk for first acute major coronary events among healthy adults with average to mildly elevated cholesterol levels and low HDL levels.
c) The Heart Protection Study (HPS) (5) randomized 20,536 subjects to daily simvastatin (40mg) or placebo and to antioxidants or placebo (the antioxidant arm did not show any benefit or harm). The study focused on patients who were deemed high risk but not thought to merit treatment with statins based on the prevalent clinical practice. Increased risk was defined as presence of or history of Coronary Artery Disease, cerebovascular disease, peripheral vascular disease, diabetes mellitus, or treated hypertension in men younger than 65 years. Simvastatin therapy was associated with a 17 per cent relative reduction in the risk of death, driven primarily by a 17 per cent relative risk reduction in nonfatal MI, a 25 per cent relative reduction in the incidence of first stroke, 30 per cent reduction in coronary revascularisation, and 16 per cent reduction in noncoronary revascularization procedures were observed. Event reduction was similar across multiple subgroups and was largely uninfluenced by pretreatment lipoprotein values. Treating LDL levels less than 100mg/dL was also associated with a beneficial reduction in vascular events.