THE EFFECT OF PRAVASTATIN ON CORONARY EVENTS AFTER MYOCARDIAL-INFARCTION IN PATIENTS WITH AVERAGE CHOLESTEROL LEVELS

Background In patients with high cholesterol levels, lowering the chol esterol level reduces the risk of coronary events, but the effect of l owering cholesterol levels in the majority of patients with coronary d isease, who have average levels, is less clear. Methods in a double-bl ind trial lasting five years, we administered either 40 mg of pravasta tin per day or placebo to 4159 patients (3583 men and 576 women) with myocardial infarction who had plasma total cholesterol levels below 24 0 mg per deciliter (mean, 209) and low-density lipoprotein (LDL) chole sterol levels of 115 to 174 mg per deciliter (mean, 139). The primary end point was a fatal coronary event or a nonfatal myocardial infarcti on. Results The frequency of the primary end point was 10.2 percent in the pravastatin group and 13.2 percent in the placebo group, an absol ute difference of 3 percentage points and a 24 percent reduction in ri sk (95 percent confidence interval, 9 to 36 percent; P=0.003). Coronar y bypass surgery was needed in 7.5 percent of the patients in the prav astatin group and 10 percent of those in the placebo group, a 26 perce nt reduction (P=0.005), and coronary angioplasty was needed in 8.3 per cent of the pravastatin group and 10.5 percent of the placebo group, a 23 percent reduction (P=0.01). The frequency of stroke was reduced by 31 percent (P=0.03). There were no significant differences in overall mortality or mortality from noncardiovascular causes. Pravastatin low ered 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. Conclusions These results demo nstrate that the benefit of cholesterol-lowering therapy extends to th e majority of patients with coronary disease who have average choleste rol levels. (C) 196 Massachusetts Medical Society.