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(Circulation. 1998;98:2513-2519.)
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiovascular Events and Their Reduction With Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors With Average Cholesterol Levels
Subgroup Analyses in the Cholesterol And Recurrent Events (CARE) Trial
From the University of Miami School of Medicine, Miami, Fla (R.B.G.); the University of Texas School of Public Health, Houston, Tex (L.A.M., B.R.D.); Bristol Myers Squibb, Princeton, NJ (M.J.M.); Medlantic Research Institute, Washington, DC (B.V.H.); Washington Hospital Center, Washington, DC (W.J.H.); Washington University, St. Louis, Mo (T.G.C.); and Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (F.M.S., M.A.P., E.B.).
Correspondence to Frank M. Sacks, MD, Nutrition Department, Harvard School of Public Health, 665 Huntington Ave, Boston, MA 02115. E-mail fsacks{at}hsph.harvard.edu
Background—Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels.
Methods and Results—The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes—136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides—were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P=0.05) and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, –50%, P=0.05 for nonfatal MI).
Conclusions—Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.
Key Words: diabetes mellitus • coronary disease • glucose • lipoproteins
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|
|
|
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|
|
|
|
 |
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|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
 W. Li, T. Asagami, H. Matsushita, K.-H. Lee, and P. S. Tsao Rosuvastatin Attenuates Monocyte-Endothelial Cell Interactions and Vascular Free Radical Production in Hypercholesterolemic Mice J. Pharmacol. Exp. Ther., May 1, 2005; 313(2): 557 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 C. S. Fox, S. Coady, P. D. Sorlie, D. Levy, J. B. Meigs, R. B. D'Agostino Sr, P. W. F. Wilson, and P. J. Savage Trends in Cardiovascular Complications of Diabetes JAMA, November 24, 2004; 292(20): 2495 - 2499. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
 |
|
 H. J. Woerle, W. P. Pimenta, C. Meyer, N. R. Gosmanov, E. Szoke, T. Szombathy, A. Mitrakou, and J. E. Gerich Diagnostic and Therapeutic Implications of Relationships Between Fasting, 2-Hour Postchallenge Plasma Glucose and Hemoglobin A1c Values Arch Intern Med, August 9, 2004; 164(15): 1627 - 1632. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 S. M. Grundy, J. I. Cleeman, C. N. B. Merz, H. B. Brewer Jr, L. T. Clark, D. B. Hunninghake, R. C. Pasternak, S. C. Smith Jr, N. J. Stone, for the Coordinating Committee of the National Cho, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Arterioscler. Thromb. Vasc. Biol., August 1, 2004; 24(8): e149 - e161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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