pretreatment LDL cholesterol level was 3.82 mmol/L. The average length of follow up was 4.3 years.

In patients at moderate to moderately high risk of cardiovascular disease, statin therapy reduced the relative risk for major coronary events by 29.2%, nonfatal myocardial infarction by 31.7%, major cerebrovascular events by 14.4% and revascularisations by 33.8%. However, the rates of coronary heart disease and overall mortality were not significantly reduced. No significant increase in cancer or in levels of creatine kinase or liver enzymes was seen.

The authors calculated that primary prevention with statin therapy appeared to be cost effective for high risk patients who have a 10 year coronary artery event rate higher than 20%. The routine use of statins as primary prevention in patients at intermediate risk (i.e. a 10 year coronary heart disease risk of 10 to 20%) is controversial, they said. Although universal lipid lowering therapy for this group appears attractive, further studies are needed to clarify the cost effectiveness, they said.