Copyright 1999 American Medical Association.
All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: The
AFCAPS/TexCAPS trial explores whether statin treatment should be
extended to subjects without evidence of cardiovascular disease and
with average total cholesterol and LDL-C levels but less than average
high-density lipoprotein cholesterol (HDL-C) levels.1
AFCAPS/TexCAPs shows substantially lower benefits than previous
trials in higher-risk subjects, although, unfortunately, results are
presented in a noncomparable format. For 1 patient to avoid a primary
end point (fatal or nonfatal MI, unstable angina, or sudden cardiac
death), 244 patients have to be treated per year (NNT per year). Are
the benefits achieved clinically important or a defensible use of
resources? Although statins are generally well tolerated, there must be
concern about medicalizing so many "healthy" subjects for such rare
benefits. Furthermore, benefits of treatment appear concentrated in
those with the greatest level of risk. If the authors had shown the
17% of patients who met existing National Cholesterol Education Panel
(NCEP) guidance in 1 stratum and the 83% who did not in the other,
would the benefits in the majority of patients have looked even less
impressive? By excluding 12.4% of patients who smoked, the NNT per
year increases to more than 300.
Mason JM, Freemantle N. Coronary Events With Lipid-Lowering Therapy: The AFCAPS/TexCAPS Trial. JAMA. 1999;281(5):414–419. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-5-jbk0203
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