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To the Editor: The meta-analysis by Dr LaRosa and colleagues¹ demonstrated that statins reduce the risk of coronary heart disease for all patients regardless of sex or age. However, LaRosa et al did not distinguish between primary and secondary prevention. Since primary prevention potentially includes a large segment of the population, it is important to examine these data separately. The West of Scotland Coronary Prevention Study (WOSCOPS) trial² showed that primary prevention is effective for men aged 45 to 64 years, and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)³ extended this benefit to 73 years. Women were not included in the WOSCOPS trial, and the analysis of LaRosa et al showed a nonsignificant effect for women in the AFCAPS/TexCAPS trial.

Thus, the evidence supporting statins for primary prevention is limited. We currently have no evidence that statins (or any other drugs) are effective for the primary prevention of coronary . . . [Full Text of this Article]

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