REDUCTION IN CARDIOVASCULAR EVENTS DURING PRAVASTATIN THERAPY - POOLED ANALYSIS OF CLINICAL EVENTS OF THE PRAVASTATIN ATHEROSCLEROSIS INTERVENTION PROGRAM

Background It has been documented that the HMG coenzyme A reductase in hibitors, 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 sever ely 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 o f the effect of that agent on the risk of coronary events. All trials were double-masked, placebo-controlled designs that used pravastatin a s monotherapy for 2 to 3 years. The 1891 participants in the trials ha d evidence of atherosclerosis and mildly to moderately elevated lipid levels. For fatal or nonfatal myocardial infarction, there was a 62% r eduction in events attributable to pravastatin (P=.001). This effect w as 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 n ot 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 str ong evidence that pravastatin reduces the risk of cardiovascular event s in patients with atherosclerotic disease and mildly to moderately el evated lipid levels. The benefit for reducing myocardial infarction is evident in older and younger patients, men and women, and patients wi th and without histories of hypertension and prior infarction.