(Circulation. 1995;92:2419-2425.)
© 1995 American Heart Association, Inc.
Articles |
Reduction in Cardiovascular Events During Pravastatin Therapy
Pooled Analysis of Clinical Events of the Pravastatin Atherosclerosis Intervention Program
From the Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC (R.P.B., H.H., C.D.F.); the Department of Cardiology, University Hospital Leiden and Interuniversity Cardiology Institute of the Netherlands, Utrecht (J.W.J., A.V.B.); the University of Michigan Hospital, Ann Arbor (B.P.); the Research Institute of Public Health, University of Kuopio (Finland) (J.T.S.); and the University of British Columbia, Vancouver, Canada (G.B.J.M.).
Correspondence to Robert P. Byington, PhD, Department of Public Health Sciences, Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1063. E-mail byington@phs.bgsm.wfu.edu.
Background It has been documented that the HMG coenzyme A reductase inhibitors, or statins, can decrease cardiovascular events and mortality in patients with clinical coronary disease and moderately to severely elevated lipid levels. Additional data are required to demonstrate a reduction of vascular events in coronary patients with less than severely elevated lipid levels and in subgroups of this population.
Methods and Results Clinical data from four atherosclerosis regression trials that evaluated pravastatin were pooled for a predetermined analysis of the effect of that agent on the risk of coronary events. All trials were double-masked, placebo-controlled designs that used pravastatin as monotherapy for 2 to 3 years. The 1891 participants in the trials had evidence of atherosclerosis and mildly to moderately elevated lipid levels. For fatal or nonfatal myocardial infarction, there was a 62% reduction in events attributable to pravastatin (P=.001). This effect was evident in younger and older patients, men and women, and patients with and without histories of hypertension and prior infarction. There was a 46% reduction in all-cause mortality (P=.17), which, although not statistically significant, is consistent with the results of other statin trials. There also was a 62% reduction in the risk of fatal or nonfatal stroke (P=.054).
Conclusions These pooled results provide strong evidence that pravastatin reduces the risk of cardiovascular events in patients with atherosclerotic disease and mildly to moderately elevated lipid levels. The benefit for reducing myocardial infarction is evident in older and younger patients, men and women, and patients with and without histories of hypertension and prior infarction.
Key Words: pravastatin • cardiovascular diseases • trials • meta-analysis
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