PHARMACOTHERAPY REVIEW CNS STIMULANTS for treatment of ...

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APPENDIX ASummary of Selected Clinical TrialsDocumenting the Effectiveness and Safetyof Selected Statins in CVD Risk ReductionPrimary PreventionAFCAPS/TexCAPS (lovastatin)WOSCOPS (pravastatin)Secondary Prevention4S (simvastatin)LIPID (pravastatin)CARE (pravastatin)MIRACL (atorvastatin)Safety/OtherPPP (pravastatin)EXCEL (lovastatin)MRC/BHF (simvastatin)GOALLS (simvastatin)13
AFCAPS/TexCAPS(The Air Force/ Texas Coronary Atherosclerosis Prevention Study)• Randomized, Double-blind, primary prevention, 6605 pts• Treatment with lovastatin 20-40 mg/day resulted in 25% reduction in LDL, 6% HDLincrease, 37% reduction in risk of first acute major coronary event.• Persons with average TC and LDL levels and below average HDL may obtain significantclinical benefit from primary prevention lipid modification. On-treatment apoB, whencombined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDLof risk of first coronary event.• Triglycerides reduced by 15 %, ApoB reduced by 18.9%, Apo B/AI reduced by 23.9%• Participants in the highest tertile for the ApoB/AI ratio appeared to be at the greatest risk foran event.• Lipid modification with lovastatin abolishes the excess risk for CHD associated with havinga low HDL level at baseline.• There is no evidence from this trial to support a threshold of benefit below which LDLreduction is not of clinical benefit.• Although on-treatment LDL failed to predict risk in this trial, on-treatment ApoB and theratio of apoB/AI proved to be significant primary predictors of coronary risk.• The Quebec Cardiovascular Study documented that apoB is a more powerful independentpredictor of CHD than LDL.• These result suggest that reconsideration be given to apoB and AI in risk assessment and thattreatment goals based on apoB or the apoB/AI ratio be further explored in certain populations14
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