Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)

Antonio M. Gotto, Edwin Whitney, Evan A. Stein, Deborah R. Shapiro, Michael Clearfield, Stephen Weis, Jesse Y. Jou, Alexandra Langendörfer, Polly A. Beere, Douglas J. Watson, John R. Downs, John S. De Cani

Research output: Contribution to journalArticle

482 Citations (Scopus)

Abstract

Background - The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is the first primary-prevention study in a cohort with average total cholesterol (TC) and LDL cholesterol (LDL-C) and below-average HDL cholesterol (HDL-C). Treatment with lovastatin (20 to 40 mg/d) resulted in a 25% reduction in LDL-C and a 6% increase in HDL-C, as well as a 37% reduction in risk for first acute major coronary event (AMCE), defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. This article describes the relation between baseline and on-treatment lipid and apolipoprotein (apo) parameters and subsequent risk for AMCEs. Methods and Results - With all available data from the entire 6605-patient cohort, a prespecified Cox backward stepwise regression model identified outcome predictors, and logistic regression models examined the relation between lipid variables and AMCE risk. Baseline LDL-C, HDL-C, and apoB were significant predictors of AMCE; only on-treatment apoB and the ratio of apoB to apoAI were predictive of subsequent risk; on-treatment LDL-C was not. When event rates were examined across tertiles of baseline lipids, a consistent benefit of treatment with lovastatin was observed. Conclusions - Persons with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification. On-treatment apoB, especially when combined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDL-C of risk for first AMCE.

Original languageEnglish
Pages (from-to)477-484
Number of pages8
JournalCirculation
Volume101
Issue number5
DOIs
StatePublished - 8 Feb 2000

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LDL Cholesterol
Apolipoproteins B
Coronary Artery Disease
Air
Lipids
HDL Cholesterol
Lovastatin
Primary Prevention
Therapeutics
Logistic Models
Cholesterol
Apolipoproteins
Sudden Cardiac Death
Unstable Angina
Risk Reduction Behavior
Myocardial Infarction

Keywords

  • Apolipoproteins
  • Coronary disease
  • Lipids
  • Prevention
  • Risk factors

Cite this

Gotto, Antonio M. ; Whitney, Edwin ; Stein, Evan A. ; Shapiro, Deborah R. ; Clearfield, Michael ; Weis, Stephen ; Jou, Jesse Y. ; Langendörfer, Alexandra ; Beere, Polly A. ; Watson, Douglas J. ; Downs, John R. ; De Cani, John S. / Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). In: Circulation. 2000 ; Vol. 101, No. 5. pp. 477-484.
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abstract = "Background - The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is the first primary-prevention study in a cohort with average total cholesterol (TC) and LDL cholesterol (LDL-C) and below-average HDL cholesterol (HDL-C). Treatment with lovastatin (20 to 40 mg/d) resulted in a 25{\%} reduction in LDL-C and a 6{\%} increase in HDL-C, as well as a 37{\%} reduction in risk for first acute major coronary event (AMCE), defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. This article describes the relation between baseline and on-treatment lipid and apolipoprotein (apo) parameters and subsequent risk for AMCEs. Methods and Results - With all available data from the entire 6605-patient cohort, a prespecified Cox backward stepwise regression model identified outcome predictors, and logistic regression models examined the relation between lipid variables and AMCE risk. Baseline LDL-C, HDL-C, and apoB were significant predictors of AMCE; only on-treatment apoB and the ratio of apoB to apoAI were predictive of subsequent risk; on-treatment LDL-C was not. When event rates were examined across tertiles of baseline lipids, a consistent benefit of treatment with lovastatin was observed. Conclusions - Persons with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification. On-treatment apoB, especially when combined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDL-C of risk for first AMCE.",
keywords = "Apolipoproteins, Coronary disease, Lipids, Prevention, Risk factors",
author = "Gotto, {Antonio M.} and Edwin Whitney and Stein, {Evan A.} and Shapiro, {Deborah R.} and Michael Clearfield and Stephen Weis and Jou, {Jesse Y.} and Alexandra Langend{\"o}rfer and Beere, {Polly A.} and Watson, {Douglas J.} and Downs, {John R.} and {De Cani}, {John S.}",
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Gotto, AM, Whitney, E, Stein, EA, Shapiro, DR, Clearfield, M, Weis, S, Jou, JY, Langendörfer, A, Beere, PA, Watson, DJ, Downs, JR & De Cani, JS 2000, 'Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)', Circulation, vol. 101, no. 5, pp. 477-484. https://doi.org/10.1161/01.CIR.101.5.477

Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). / Gotto, Antonio M.; Whitney, Edwin; Stein, Evan A.; Shapiro, Deborah R.; Clearfield, Michael; Weis, Stephen; Jou, Jesse Y.; Langendörfer, Alexandra; Beere, Polly A.; Watson, Douglas J.; Downs, John R.; De Cani, John S.

In: Circulation, Vol. 101, No. 5, 08.02.2000, p. 477-484.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Relation between baseline and on-treatment lipid parameters and first acute major coronary events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)

AU - Gotto, Antonio M.

AU - Whitney, Edwin

AU - Stein, Evan A.

AU - Shapiro, Deborah R.

AU - Clearfield, Michael

AU - Weis, Stephen

AU - Jou, Jesse Y.

AU - Langendörfer, Alexandra

AU - Beere, Polly A.

AU - Watson, Douglas J.

AU - Downs, John R.

AU - De Cani, John S.

PY - 2000/2/8

Y1 - 2000/2/8

N2 - Background - The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is the first primary-prevention study in a cohort with average total cholesterol (TC) and LDL cholesterol (LDL-C) and below-average HDL cholesterol (HDL-C). Treatment with lovastatin (20 to 40 mg/d) resulted in a 25% reduction in LDL-C and a 6% increase in HDL-C, as well as a 37% reduction in risk for first acute major coronary event (AMCE), defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. This article describes the relation between baseline and on-treatment lipid and apolipoprotein (apo) parameters and subsequent risk for AMCEs. Methods and Results - With all available data from the entire 6605-patient cohort, a prespecified Cox backward stepwise regression model identified outcome predictors, and logistic regression models examined the relation between lipid variables and AMCE risk. Baseline LDL-C, HDL-C, and apoB were significant predictors of AMCE; only on-treatment apoB and the ratio of apoB to apoAI were predictive of subsequent risk; on-treatment LDL-C was not. When event rates were examined across tertiles of baseline lipids, a consistent benefit of treatment with lovastatin was observed. Conclusions - Persons with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification. On-treatment apoB, especially when combined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDL-C of risk for first AMCE.

AB - Background - The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) is the first primary-prevention study in a cohort with average total cholesterol (TC) and LDL cholesterol (LDL-C) and below-average HDL cholesterol (HDL-C). Treatment with lovastatin (20 to 40 mg/d) resulted in a 25% reduction in LDL-C and a 6% increase in HDL-C, as well as a 37% reduction in risk for first acute major coronary event (AMCE), defined as fatal or nonfatal myocardial infarction, unstable angina, or sudden cardiac death. This article describes the relation between baseline and on-treatment lipid and apolipoprotein (apo) parameters and subsequent risk for AMCEs. Methods and Results - With all available data from the entire 6605-patient cohort, a prespecified Cox backward stepwise regression model identified outcome predictors, and logistic regression models examined the relation between lipid variables and AMCE risk. Baseline LDL-C, HDL-C, and apoB were significant predictors of AMCE; only on-treatment apoB and the ratio of apoB to apoAI were predictive of subsequent risk; on-treatment LDL-C was not. When event rates were examined across tertiles of baseline lipids, a consistent benefit of treatment with lovastatin was observed. Conclusions - Persons with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification. On-treatment apoB, especially when combined with apoAI to form the apoB/AI ratio, may be a more accurate predictor than LDL-C of risk for first AMCE.

KW - Apolipoproteins

KW - Coronary disease

KW - Lipids

KW - Prevention

KW - Risk factors

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