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To the Editor: The Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) provides further evidence on the benefit of statin treatment for primary prevention of coronary heart disease (CHD).¹ The relative risk (RR) reduction for nonfatal myocardial infarction (MI) and CHD death (42%) was broadly similar to that in previous statin trials. However, the population studied had a much lower risk of CHD than those enrolled in previous studies, with a rate of nonfatal MI and CHD death in the placebo group of 0.6% per year. As a result, the absolute risk reduction for these events was much smaller than in previous trials, at around 0.2% per year. This corresponds to a number needed to treat (NNT) of 86 to prevent 1 CHD event over 5 years.

There is now broad agreement that lipid-lowering treatment should be targeted at a specified level of absolute CHD risk^2-4 because this risk determines absolute . . . [Full Text of this Article]