1. JAMA. 1984 Jan 20;251(3):351-64.

The Lipid Research Clinics Coronary Primary Prevention Trial results. I.
Reduction in incidence of coronary heart disease.

[No authors listed]

The Lipid Research Clinics Coronary Primary Prevention Trial (LRC-CPPT), a
multicenter, randomized, double-blind study, tested the efficacy of cholesterol
lowering in reducing risk of coronary heart disease (CHD) in 3,806 asymptomatic
middle-aged men with primary hypercholesterolemia (type II hyperlipoproteinemia).
The treatment group received the bile acid sequestrant cholestyramine resin and
the control group received a placebo for an average of 7.4 years. Both groups
followed a moderate cholesterol-lowering diet. The cholestyramine group
experienced average plasma total and low-density lipoprotein cholesterol (LDL-C) 
reductions of 13.4% and 20.3%, respectively, which were 8.5% and 12.6% greater
reductions than those obtained in the placebo group. The cholestyramine group
experienced a 19% reduction in risk (p less than .05) of the primary end
point--definite CHD death and/or definite nonfatal myocardial
infarction--reflecting a 24% reduction in definite CHD death and a 19% reduction 
in nonfatal myocardial infarction. The cumulative seven-year incidence of the
primary end point was 7% in the cholestyramine group v 8.6% in the placebo group.
In addition, the incidence rates for new positive exercise tests, angina, and
coronary bypass surgery were reduced by 25%, 20%, and 21%, respectively, in the
cholestyramine group. The risk of death from all causes was only slightly and not
significantly reduced in the cholestyramine group. The magnitude of this decrease
(7%) was less than for CHD end points because of a greater number of violent and 
accidental deaths in the cholestyramine group. The LRC-CPPT findings show that
reducing total cholesterol by lowering LDL-C levels can diminish the incidence of
CHD morbidity and mortality in men at high risk for CHD because of raised LDL-C
levels. This clinical trial provides strong evidence for a causal role for these 
lipids in the pathogenesis of CHD.

PMID: 6361299  [Indexed for MEDLINE]