Abstract 14898: Importance of Multifactorial Risk Management Under Pravastatin
Aim: Statins are known to effectively prevent the incidence of cardiovascular diseases. Yet, 60-70% of patients remain at risk of developing cardiovascular diseases. To determine how to optimize cardiovascular health, we sought to assess the relationship between traditional risk factors and development of coronary heart disease (CHD) under treating of the pravastatin.
Material and Methods: The MEGA Study in 7832 Japanese patients with mild to moderate hypercholesterolemia showed that low-dose pravastatin (10-20 mg/day) plus NCEP step I diet reduced by 33% the incidence of CHD compared to diet alone. In this post hoc analysis, we compared the 5-year incidence rates for CHD in patients with or without other traditional risk factors (2249 and 5583 patients, respectively), and evaluated the effects of pravastain using the Cox proportional hazard model. Traditional risk factors assessed were: obesity, hypertension, diabetes, low HDL-cholesterol, and current smoking.
Results: In the diet alone group, the 5-year incidence of CHD was 1.76/1000 person-years in the group without traditional risk factors and 5.95/1000 person-years (Hazard ratio 2.6, p=0.0067) in the group with traditional risk factors, whereas in the diet plus pravastatin group, the 5-year incidence of CHD was 0.40/1000 person-years in the patients without other traditional risk factors, compared to 4.47/1000 person-years in the patients with traditional risk factors (Hazard ratio 9.2, p=0.0021). The incidence of CHD in diet plus pravastatin group was lower by 73% and 25% compared to diet alone group in the patients with and without traditional risk, respectively. The most common risk factors in the patients who experienced CHD in the diet plus pravastatin group with traditional risk factors were hypertension and/or diabetes (42/55 patients, 76.3%), whose average blood pressure level and fasting glucose level during follow up were 138/81 mmHg and 8.4 mmol/L.
Conclusion: The more marked reductions in the patients with hypercholesterolemia as their only risk factor underscores the necessity of prevention and management beyond lipids. More intensive multifactorial risk management is required to help patients achieve their good cardiovascular health.
- © 2010 by American Heart Association, Inc.