Am J Cardiol. 1997 Mar 15;79(6):756-62. doi: 10.1016/s0002-9149(96)00863-6.
The West of Scotland Coronary Prevention Study recently demonstrated the benefits of pravastatin therapy in the prevention of coronary heart disease events in middle-aged hypercholesterolemic men without prior myocardial infarction. We present an analysis of the influence of baseline risk factors on coronary events and total mortality in the trial, and their interaction with therapy, using the Cox proportional hazards model. The multivariate predictors of fatal or nonfatal coronary events were treatment allocation (pravastatin or placebo), current smoking, diabetes mellitus, nitrate consumption, minor electrocardiographic abnormalities, angina pectoris, family history of premature coronary death, widowhood, blood pressure, and total cholesterol/high density lipoprotein cholesterol ratio. Independent of other risk factors, pravastatin reduced the risk of definite coronary heart disease death or nonfatal myocardial infarction by 32% (95% confidence interval 17 to 44, p = 0.0001), definite or suspected coronary heart disease death by 35% (3 to 56, p = 0.035), cardiovascular death by 33% (4 to 53, p = 0.027), coronary revascularization procedures by 38% (11 to 56, p = 0.009), and all-cause mortality by 24% (2 to 41, p = 0.037). The 5-year risk of fatal or nonfatal myocardial infarction, calculated using the predictors identified in the Cox analysis, ranged from <4.4% in the lowest quartile of risk to >9.6% in the highest quartile. The proportional benefit achieved by pravastatin was independent of other risk factors; hence, the absolute benefit of therapy was greatest in subjects with the highest baseline risk. Such subjects can be identified easily in the population and deserve high priority for treatment.
苏格兰西部冠心病预防研究最近证明了普伐他汀治疗在预防无既往心肌梗死的中年高胆固醇血症男性冠心病事件中的益处。我们使用Cox比例风险模型对该试验中基线风险因素对冠心病事件和总死亡率的影响及其与治疗的相互作用进行了分析。致命或非致命性冠心病事件的多变量预测因素包括治疗分配（普伐他汀或安慰剂）、当前吸烟、糖尿病、硝酸盐消耗、轻微心电图异常、心绞痛、早发冠心病死亡家族史、丧偶、血压以及总胆固醇/高密度脂蛋白胆固醇比值。独立于其他风险因素，普伐他汀使确诊的冠心病死亡或非致命性心肌梗死风险降低32%（95%置信区间为17%至44%，p = 0.0001），确诊或疑似冠心病死亡风险降低35%（3%至56%，p = 0.035），心血管死亡风险降低33%（4%至53%，p = 0.027），冠状动脉血运重建术风险降低38%（11%至56%，p = 0.009），全因死亡率降低24%（2%至41%，p = 0.037）。使用Cox分析中确定的预测因素计算得出的5年致命或非致命性心肌梗死风险范围为，风险最低四分位数中的风险<4.4%至最高四分位数中的风险>9.6%。普伐他汀所带来的比例性益处独立于其他风险因素；因此，治疗的绝对益处在基线风险最高的受试者中最大。这类受试者在人群中很容易被识别出来，值得优先接受治疗。
