Lancet. 1996 Nov 16;348(9038):1339-42.
We assessed the potential benefit of treatment for low-risk and high-risk groups in the West of Scotland Coronary Prevention Study (WOSCOPS) population, and compared the benefits of primary and secondary prevention of coronary heart disease (CHD) by lipid lowering with the benefits of blood pressure reduction in the primary prevention of stroke.
We did a subgroup analysis of placebo-treated men in the WOSCOPS population by age, vascular disease at trial entry, and other established risk factors. We also compared WOSCOPS findings with those of the Scandinavian Simvastatin Survival Study (4S) and the Medical Research Council (MRC) trial of treatment for mild to moderate hypertension in middle-aged men. The WOSCOPS population comprised 6595 men aged 45-64 years with no history of myocardial infarction (MI) and plasma total cholesterol concentrations of 6.5-8.0 mmol/L at initial screening. Participants were randomly allocated pravastatin (40 mg daily) or placebo, and followed up for an average of 4.9 years.
Coronary event rates at 5 years in the WOSCOPS placebo group were higher than 10% (the recommended treatment threshold) in men with pre-existing vascular disease and in those 55 years or older without symptoms or signs of CHD but with at least one other risk factor. Event rates were low in men with hypercholesterolaemia but no other risk factor: 3.5% (95% CI 1.3-5.7) for men aged 45-54 years and 5.3% (2.7-8.0) for men aged 55-64 years. Three times more men had to be treated for 5 years to prevent one endpoint in WOSCOPS than in 4S. By contrast, two to four times fewer men with hyperlipidaemia were treated to save one coronary event in WOSCOPS than hypertensives to save one stroke in the MRC trial. These differences persisted after adjustment for the low-risk status of many of the patients with hypertension who took part in the MRC trial.
There were a substantial number of men whose risk of a coronary event was more than 10% at 5 years in the WOSCOPS cohort. The absolute benefit of pravastatin treatment of hyperlipidaemia is less in the primary prevention of CHD than in secondary prevention, but is similar to that for primary prevention of stroke by treatment of mild to moderate hypertension in middle-aged men.
我们在苏格兰西部冠心病预防研究（WOSCOPS）人群中评估了低风险和高风险组治疗的潜在益处，并比较了通过降低血脂进行冠心病（CHD）一级和二级预防的益处与通过降低血压进行中风一级预防的益处。
我们按年龄、试验入组时的血管疾病以及其他既定风险因素，对WOSCOPS人群中接受安慰剂治疗的男性进行了亚组分析。我们还将WOSCOPS的研究结果与斯堪的纳维亚辛伐他汀生存研究（4S）以及医学研究委员会（MRC）针对中年男性轻度至中度高血压治疗试验的结果进行了比较。WOSCOPS人群包括6595名年龄在45 - 64岁之间、无心肌梗死（MI）病史且初次筛查时血浆总胆固醇浓度为6.5 - 8.0 mmol/L的男性。参与者被随机分配接受普伐他汀（每日40 mg）或安慰剂治疗，并平均随访4.9年。
在WOSCOPS安慰剂组中，5年时冠心病事件发生率在已有血管疾病的男性以及55岁及以上、无CHD症状或体征但至少有一项其他风险因素的男性中高于10%（推荐治疗阈值）。在仅有高胆固醇血症但无其他风险因素的男性中，事件发生率较低：45 - 54岁男性为3.5%（95% CI 1.3 - 5.7），55 - 64岁男性为5.3%（2.7 - 8.0）。在WOSCOPS中，为预防一个终点事件，需要治疗5年的男性人数是4S中的3倍。相比之下，在WOSCOPS中，为挽救一次冠心病事件而接受治疗的高脂血症男性人数比在MRC试验中为挽救一次中风事件而接受治疗的高血压男性人数少两至四倍。在对参与MRC试验的许多高血压患者的低风险状态进行调整后，这些差异仍然存在。
在WOSCOPS队列中，有相当数量的男性在5年时发生冠心病事件的风险超过10%。在CHD一级预防中，普伐他汀治疗高脂血症的绝对益处低于二级预防，但与中年男性通过治疗轻度至中度高血压进行中风一级预防的益处相似。
