Letters to the Editor
REPORT ON UPDATES IN HYPERLIPIDAEMIA THERAPY
A seminar on "Updates in Hyperlipidaemia Therapy" was held on 3 January 1997 at the Shangri-la Hotel. The speaker was Cardiologist, Professor Eugene Braunwald, Distinguished Hersey Professor of Medicine, Harvard Medical School, Faculty Dean for Academic Programmes of Brigham Women's & Massachusetts General Hospitals and the Co-Editor of Harrison's Principles of Internal Medicine. Dr Tan Hooi Hwa reports on the seminar organised by Singapore Cardiac Society and Endocrine & Metabolic Society of Singapore.
This seminar focused on 1 of the 3 important trials published in the last 2 years on the effect of cholesterol reduction on cardiovascular events. They were:
1. 4S Overall Survival (Scandinavian Simvastatin Survival Study) in patients with coronary heart disease (CHD) (Lancet 1994) and raised cholesterol level. (221 - 350mg%). The results showed that with a marked reduction of cholesterol, the mortality of patients, and the need for intervention (viz. Angioplasty and CABG), was reduced by 30% over a 5 year follow up.
2. West of Scotland, coronary presentation study in patients with raised cholesterol and no previous coronary heart disease, the effect of pravastatin monotherapy in lowering cholesterol, was to reduce by 31% the risk of coronary events over a 6 year follow up. This study was conducted in a male population aged 45 - 64 with cholesterol > 252mg%.
3. CARE (Cholesterol & Recurrent Events) Study in North America.
(New England Journal of Medicine, 1996). This was a secondary prevention
trial in post myocardial infarction patients with average cholesterol levels.
This study included males and females aged 21-75 years old (average 59
years), in a double blind trial lasting 5 years. 40mg pravastatin or placebo
The result showed:
The presence of breast cancer: 1 patient in the placebo group and 12 in the pravastatin group could not be explained as due to the effect of drug, as 3 occurred in patient with previous breast cancer and 1 was ductal carcinoma and 1 occurred in a patient who took the drug for only 6 weeks. In Professor Braunwald's opinion, it was probably a random occurrence.