Cited by 185Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCancer, Lipids, and Metabolism

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Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up

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Vallejo-Vaz, Antonio J., Robertson, Michele, Catapano, Alberico L., Watts, Gerald F., Kastelein, John J., Packard, Chris J., Ford, Ian, Ray, Kausik K.·2017·Circulation

DOI 10.1161/circulationaha.117.027966

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Abstract

Background: Patients with primary elevations of low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are at a higher risk of atherosclerotic cardiovascular disease as a result of long-term exposure to markedly elevated LDL-C levels. Therefore, initiation of statin therapy is recommended for these individuals. However, there is a lack of randomized trial evidence supporting these recommendations in primary prevention. In the present analysis, we provide hitherto unpublished data on the cardiovascular effects of LDL-C lowering among a primary prevention population with LDL-C ≥190 mg/dL. Methods: We aimed to assess the benefits of LDL-C lowering on cardiovascular outcomes among individuals with primary elevations of LDL-C ≥190 mg/dL without preexisting vascular disease at baseline. We performed post hoc analyses from the WOSCOPS (West of Scotland Coronary Prevention Study) randomized, placebo-controlled trial, and observational posttrial long-term follow-up, after excluding individuals with evidence of vascular disease at baseline. WOSCOPS enrolled 6595 men aged 45 to 64 years, who were randomly assigned to pravastatin 40 mg/d or placebo. In the present analyses, 5529 participants without evidence of vascular disease were included, stratified by LDL-C levels into those with LDL-C <190 mg/dL (n=2969; mean LDL-C 178±6 mg/dL) and those with LDL-C ≥190 mg/dL (n=2560; mean LDL-C 206±12 mg/dL). The effect of pravastatin versus placebo on coronary heart disease and major adverse cardiovascular events were assessed over the 4.9-year randomized controlled trial phase and on mortality outcomes over a total of 20 years of follow-up. Results: Among 5529 individuals without vascular disease, pravastatin reduced the risk of coronary heart disease by 27% ( P =0.002) and major adverse cardiovascular events by 25% ( P =0.004) consistently among those with and without LDL-C ≥190 mg/dL ( P -interaction >0.9). Among individuals with LDL-C ≥190 mg/dL, pravastatin reduced the risk of coronary heart disease by 27% ( P =0.033) and major adverse cardiovascular events by 25% ( P =0.037) during the initial trial phase and the risk of coronary heart disease death, cardiovascular death, and all-cause mortality by 28% ( P =0.020), 25% ( P =0.009), and 18% ( P =0.004), respectively, over a total of 20 years of follow-up. Conclusions: The present analyses provide robust novel evidence for the short- and long-term benefits of lowering LDL-C for the primary prevention of cardiovascular disease among individuals with primary elevations of LDL-C ≥190 mg/dL.

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Response by Vallejo-Vaz et al to Letters Regarding Article, “Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up”
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Self-citation
Letter by Koh Regarding Article, “Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up”
Koh, K. K. (2018) · Circulation · doi:10.1161/circulationaha.117.033136 · Cited by 1
Letter by Löwe et al Regarding Article, “Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up”
Löwe, A., Collet, T., & Rodondi, N. (2018) · Circulation · doi:10.1161/circulationaha.117.032213
Association between Lowering Low-Density Lipoprotein Cholesterol with Pravastatin and Primary Prevention of Cardiovascular Disease in Mild to Moderate Hypercholesterolemic Japanese
Teramoto, T., Nakaya, N., Yokoyama, S., Ohashi, Y., Mizuno, K., & Nakamura, H. (2010) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.4176 · Cited by 24
Low-density lipoprotein cholesterol lowering and risk of major adverse cardiovascular events in primary prevention trials: A meta-analysis
Kalra, D. K., Ray, K. K., Bajaj, A., Kushner, P. R., Wilcox, M. L., Dicklin, M. R., Kirkpatrick, C. F., & Maki, K. C. (2026) · Journal of clinical lipidology · doi:10.1016/j.jacl.2026.02.006 · Cited by 18
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Authors: Vallejo-Vaz, A. J., Robertson, M., Catapano, A. L., Watts, G. F., Kastelein, J. J., Packard, C. J., Ford, I., & Ray, K. K.
Affiliations: Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom (A.J.V.-V., K.K.R.).
University of Glasgow (GB)
University of Milan (IT)
The University of Western Australia (AU)
Amsterdam UMC Location University of Amsterdam (NL)
Imperial College London (GB)
ORCID: Robertson, Michele
Catapano, Alberico L.
Watts, Gerald F.
Kastelein, John J.
Packard, Chris J.
Ford, Ian
Ray, Kausik K.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2017-11-14
Volume: 136
Issue: 20
Pages: 1878-1891
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.117.027966
OpenAlex: W2751778625
Cited by: 185
References: 33
Citations by year: 2026: 9 · 2025: 11 · 2024: 14 · 2023: 19 · 2022: 20 · 2021: 20 · 2020: 23 · 2019: 25 · 2018: 38 · 2017: 6
FWCI: 25.75
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion)
UWA Profiles and Research Repository (UWA) (submittedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Pure Amsterdam UMC (submittedVersion, other-oa)
Spiral (Imperial College London) (submittedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Keywords: LDL cholesterol lowering, primary prevention, hypercholesterolemia, pravastatin, statin therapy, coronary artery disease, major adverse cardiovascular events, cardiovascular mortality, atherosclerotic cardiovascular disease, WOSCOPS, men
MeSH terms: Anticholesteremic Agents, Cardiovascular Diseases, Coronary Disease, Follow-Up Studies, Humans, Hypercholesterolemia, Cholesterol, LDL, Male, Middle Aged, Primary Prevention, Scotland, Pravastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors

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