In a recent article in The New England Journal of Medicine,1 Sacks and his colleagues for the Cholesterol and Recurrent Events Trial Investigators (CARE study) determined whether lowering serum cholesterol values has a benefit on survival and morbidity in patients with coronary heart disease and “average” serum cholesterol levels. In a double-blind trial that lasted 5 years, they administered either 40 mg of pravastatin per day or placebo to 4159 patients (3583 men and 576 women) with myocardial infarction who had plasma total cholesterol levels <240 mg/dL (mean, 209 mg/dL) and LDL cholesterol values of 115 to 174 mg/dL (mean, 139 mg/dL). The primary end point in this study was a fatal coronary event or a nonfatal myocardial infarction.
The primary end point occurred in 10% of the pravastatin-treated patients and 13% of those treated with placebo, an absolute difference of 3 percentage points and a 24% reduction in risk (P=.003). Coronary bypass surgery was required in 7.5% of patients treated with pravastatin and 10% of those in the placebo group, a 26% reduction (P=.005). Coronary angioplasty was required in 8% of the pravastatin group and 11% of the placebo group (P=.01). The frequency of cerebrovascular accidents was reduced by 31% by pravastatin therapy (P=.03). There were no significant differences in overall mortality or mortality from noncardiovascular causes. Pravastatin lowered the rate of coronary events more among women than among men. The reduction in coronary events was also greater in patients with higher pretreatment levels of LDL cholesterol.
The authors conclude from this study that the benefit of cholesterol-lowering therapy extends to many patients with coronary disease who have relatively average serum cholesterol and LDL values.
- Copyright © 1996 by American Heart Association
Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JMO, Wun CC, Davis BR, Braunwald E, for the Cholesterol and Recurrent Events Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001-1009.