West of Scotland Coronary Prevention Study

Long-Term Follow-Up of a Landmark Statin Trial
The benefits of statin therapy lasted 10 years.


The West of Scotland Coronary Prevention Study was the first large randomized trial of statin therapy in people without a history of coronary events (Journal Watch Nov 28 1995). Pravastatin, compared with placebo, was associated with a significantly lower 5-year rate of death from coronary heart disease or nonfatal myocardial infarction (5.5% vs. 7.9%) and a statistically borderline reduction in all-cause mortality (3% vs. 4%). Now, researchers present an additional 10 years of follow-up data. About one third of patients in both groups were taking statins 5 years after the trial ended; no data were available for statin therapy beyond that time point.

At 15 years, the following outcomes were noted in the original pravastatin group compared with the original placebo group:


Significantly lower rate of death from CHD or nonfatal MI (12% vs. 16%)

Significantly lower CHD mortality (5% vs. 6%)

Significantly lower all-cause mortality (19% vs. 21%)

No significant difference in rates of fatal or nonfatal stroke

No significant difference in cancer rates


Comment: This partly industry-supported extended follow-up of a landmark primary prevention trial shows that the benefits of statin therapy were durable, even though only a minority of patients in both groups took statins after conclusion of the trial. The authors attribute their findings to stabilization of existing plaque and slowing of progression of coronary artery disease. Keep in mind that this study population was high-risk to begin with — participants were middle-aged men with a mean LDL cholesterol of 192 mg/dL, and most were current or ex-smokers.

— Allan S. Brett, MD

Published in Journal Watch General Medicine October 11, 2007

Citation(s):

Ford I et al. Long-term follow-up of the West of Scotland Coronary Prevention Study. N Engl J Med 2007 Oct 11; 357:1477.

Effect of Soy Intake on Blood Pressure and Lipids

In hypertensive women who added soy to their diets, blood pressure decreased.

Dietary soy is one of several factors that might explain the lower incidence of coronary heart disease in Asian countries than in Western countries. In a randomized, crossover trial, 60 healthy postmenopausal women followed the National Cholesterol Education Program (NCEP) diet or the NCEP diet with 25 g of soy protein supplied as one half cup of unsalted soy nuts (i.e., roasted soy beans) daily while maintaining an equivalent total protein content. Each phase was continued for 8 weeks, and researchers assessed the effect of the diets upon lipids and blood pressure (BP). Patients with systolic BP 165 mm Hg or diastolic BP of 100 mm Hg were excluded from the trial.

Mean BP was lower with soy than without, both among hypertensive women (137/82 vs. 152/88 mm Hg) and normotensive women (110/67 vs. 116/69 mm Hg). The soy diet was significantly lower in total and saturated fat than the control diet. Nonetheless, among normotensive women, total, LDL, and HDL cholesterol levels did not differ across diets. Among hypertensive women, LDL decreased by 11%; total and HDL cholesterol levels did not differ significantly.

Comment: In this small randomized crossover trial, adding soy protein to a diet showed impressive reductions in blood pressure; the magnitude of this effect was surprising and certainly requires confirmation. In contrast, the effect upon lipids was limited.

— Jamaluddin Moloo, MD, MPH

Published in Journal Watch General Medicine June 14, 2007

Citation(s):
Welty FK et al. Effect of soy nuts on blood pressure and lipid levels in hypertensive, prehypertensive, and normotensive postmenopausal women. Arch Intern Med 2007 May 28; 167:1060-7.