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Update in Preventive Medicine
- Laurence H. Beck, MD; and
- Seema Pania Kumar, MD
- From Cleveland Clinic Florida, Ft. Lauderdale, Florida; and Georgetown University Medical Center, Washington, D.C.
1999-2000 Series: Update Sessions from ACP-ASIM's 1999 Annual Session
Margaret Ring Gillock, Editor, and David Cramer, MD, Co-Editor
Many of the studies published in 1998 that dealt with prevention are concentrated in three areas: cardiovascular disease, breast and other cancers, and osteoporosis. The studies looking at other topics tended to be small in scale or unconvincing, or they failed to yield findings of broad interest to practicing internists.
Cardiovascular Disease
In 1998, numerous large trials of primary and secondary prevention using lipid-lowering agents uniformly claimed beneficial results. Pharmacologic cholesterol reduction has previously been shown to reduce the risk for cardiovascular death in hypercholesterolemic patients with known coronary artery disease. The use of “statin” drugs, or HMG-CoA (3-hydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors, has been extended to patients with or without known coronary artery disease who have average cholesterol levels. We describe three reports on statin therapy, along with the first prospective study evaluating hormone replacement therapy (HRT) for the secondary prevention of cardiovascular disease in postmenopausal women.
Pravastatin Reduced Coronary Mortality in a Large Placebo-Controlled Trial
Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med. 1998; 339:1349-57.
The randomized, double-blind Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) study evaluated pravastatin in approximately 9000 men and women at centers in Australia and New Zealand. The patients had had acute myocardial infarction or unstable angina within the preceding 3 to 36 months but had average cholesterol levels (baseline total plasma cholesterol levels, 4.01 to 6.99 mmol/L [155 to 271 mg/dL]). They were assigned to receive 40 mg of pravastatin daily or matched placebo, in addition to ongoing dietary advice to reduce total fat intake to less than 30% of total intake.
During an average follow-up just …
