Primary prevention of coronary heart disease: implications of the Air Force/Texas coronary atherosclerosis prevention study (AFCAPS/TexCAPS).

Over the past 15 years several studies have examined the benefits of treating patients with dyslipidemia in order to prevent a first cardiac event and to prevent the onset of clinical symptoms of coronary atherosclerosis. Some of the pitfalls of these studies have been that they have been performed predominantly in men, and also in patients with extremely high cholesterol levels. The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) provides substantial additional information regarding the benefits of primary prevention in the general population. The study included large numbers of women as well as subjects with a wide variety of ethnic backgrounds, and showed substantial benefit across this population. Patients with average cholesterol levels, but below-average high-density lipoproteins, had substantial reduction in risk of a first cardiac event with aggressive treatment of their dyslipidemia, using lovastatin. The majority of the patients in the AFCAPS/TexCAPS study would not warrant therapy, based on the current National Cholesterol Education Program Adult Treatment Panel guidelines. The data suggest that new strategies are warranted to better identify those patients who are at high risk and those who will receive benefit from aggressive lipid-lowering therapy.