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(Circulation. 2008;117:494-502.)
© 2008 American Heart Association, Inc.

Coronary Heart Disease

Usefulness of Pravastatin in Primary Prevention of Cardiovascular Events in Women

Analysis of the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA Study)

Kyoichi Mizuno, MD, PhD; Noriaki Nakaya, MD, PhD; Yasuo Ohashi, PhD; Naoko Tajima, MD, PhD; Toshio Kushiro, MD, PhD; Tamio Teramoto, MD, PhD; Shinichiro Uchiyama, MD, PhD; Haruo Nakamura, MD, PhD, for the MEGA Study Group

From the Department of Medicine, Nippon Medical School (K.M.); Nakaya Clinic (N.N.); Department of Biostatistics/Epidemiology and Preventive Health Sciences, University of Tokyo (Y.O.); Department of Internal Medicine, Jikei University School of Medicine (N.T.); Department of Internal Medicine, Nihon University Surugadai Hospital (T.K.); Department of Internal Medicine, Teikyo University School of Medicine (T.T.); Department of Neurology, Tokyo Women’s Medical University School of Medicine (S.U.); and Mitsukoshi Health and Welfare Foundation (H.N.), Tokyo, Japan.

Correspondence to Kyoichi Mizuno, MD, PhD, Department of Internal Medicine (Cardiology, Geriatrics, Hepatology and Integrated Medicine), Nippon Medical School, 1–1–5, Sendagi, Bunkyo-ku, Tokyo, 113–8603, Japan. E-mail mizunok{at}nms.ac.jp

Received November 7, 2006; accepted November 7, 2007.

Background— It is well known that statins reduce the risk of cardiovascular disease. However, the effect of statins in women for the primary prevention of cardiovascular disease has not been determined. We conducted an exploratory analysis of the effect of diet plus pravastatin therapy on the primary prevention of cardiovascular events in women with data from a large-scale primary prevention trial with pravastatin.

Methods and Results— Patients with hypercholesterolemia (5.7 to 7.0 mmol/L) and no history of coronary heart disease or stroke were randomized to diet or diet plus pravastatin 10 to 20 mg/d and followed up for 5 years. We investigated the effect of diet plus pravastatin treatment on cardiovascular events in 5356 women during the 5-year follow-up. The incidence of cardiovascular events in the women was 2 to 3 times lower than that in men. The occurrence of cardiovascular events was 26% to 37% lower in the diet plus pravastatin treatment group than in the diet alone group. Although these differences did not reach statistical significance, the overall risk reductions were similar to those in men. Notably, women 60 years of age treated with diet plus pravastatin had markedly higher risk reductions for coronary heart disease (45%), coronary heart disease plus cerebral infarction (50%), and stroke (64%) than did women treated with diet alone.

Conclusions— Treatment with pravastatin in women with elevated cholesterol but no history of cardiovascular disease provides a benefit similar to that seen in men, and this benefit is more marked in older women. This treatment should be considered routinely for primary cardiovascular protection in women with elevated cholesterol levels.

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