Cholesterol Lowering in Women - (2)

Primary cardiovascular risk prevention is of particular importance to women. Sudden cardiac death is more frequently the presenting symptom of cardiovascular disease in women than in men. In addition, women are more likely than men to die of their first MI.¹⁰ Identifying women most likely to benefit from primary intervention remains a challenge, however.

AFCAPS/TexCAPS. The Air Force Coronary Atherosclerosis Prevention Study (AFCAPS)/Texas Coronary Atherosclerosis Prevention Study (TexCAPS)¹⁵ was the only primary prevention trial with statins to include women. In it, 997 women with total cholesterol levels between 180 and 264 mg/dL, LDL cholesterol levels between 130 and 190 mg/dL, HDL cholesterol levels less than 47 mg/dL, and triglyceride levels less than 400 mg/dL were randomized to treatment with lovastatin, 20 mg/day, or placebo; the lovastatin dose was titrated to 40 mg/day if the LDL cholesterol remained above 110 mg/dL. Patients were followed up for an average of 5.2 years.

Results for the entire trial group showed a 37% reduction in risk for the primary end point of first acute major coronary event (p <.001), which included fatal or nonfatal MI, unstable angina, or sudden cardiac death. In addition, the need for revascularization was reduced by 33% (p=.001). Event rates were very low for women in this trial: 13 women in the placebo group and seven in the lovastatin group had a primary event. As a result, it is difficult to draw conclusions about the benefit of lovastatin in women.Cholesterol Lowering in Women article

AFCAPS/TexCAPS demonstrated a major clinical challenge of primary prevention: identification of women at increased risk for the development of clinical cardiovascular events. The trial included women who were at relatively low risk for a cardiovascular event. Fewer than 20% of the patients would meet current NCEP guidelines for cholesterol-lowering treatment. To reach a statistically significant conclusion about event reduction in the subgroup of women, approximately 20,000 women would have had to be included.Cholesterol Lowering in Women article

Currently, several primary prevention trials in higher risk groups are under way, including the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) in the United States and a European trial in older patients. Both of these studies include women and focus on patients with high risk-factor profiles. In addition, the Women's Health Initiative will address primary cardiovascular prevention with HRT.Cholesterol Lowering in Women article