Prevention of Coronary Heart Disease with Pravastatin

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Abstract
In the West of Scotland Coronary Prevention Study, reported by Shepherd et al. (Nov. 16 issue),1 the net benefit of taking pravastatin (40 mg per day for five years), as compared with placebo, was a 2.2 percent reduction in the combined end points of nonfatal myocardial infarction and death from coronary heart disease or a 0.7 percent reduction in the incidence of death from cardiovascular causes. Thus, 45 men with hypercholesterolemia must be treated for five years to prevent one combined end point, and 143 men must be treated to prevent one death from a cardiac cause. Pravastatin retails in the United States for about $100 for a month's supply, or $6,000 for five years. This means that $270,000 worth of pravastatin must be prescribed to prevent one combined end point and that $858,000 worth of the drug must be prescribed to prevent one death from a cardiac cause. Although the relative benefit of pravastatin in women may be similar (although unproved as yet), coronary heart disease develops in middle-aged women at about one fourth the rate in men, so the cost of preventing death from coronary heart disease in one woman would exceed $3.4 million.