Cardiovascular events and their reduction with pravastatin in diabetic andglucose-intolerant myocardial infarction survivors with average cholesterol levels - Subgroup analyses in the cholesterol and recurrent events (CARE)trial

Background-Although diabetes is a major risk factor for coronary heart dise ase (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 w ith C-KD 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 58 6 patients (14.1%) with clinical diagnoses of diabetes. The participants wi th diabetes were older, more obese, and more hypertensive. The mean baselin e 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 tho se in the nondiabetic group, LDL cholesterol reduction by pravastatin was s imilar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronar y events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) t han did the nondiabetic patients (37% versus 25%). Pravastatin treatment re duced 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 revascular ization procedures by 32% (P=0.04) in the diabetic patients. Ln the 3553 pa tients 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, 1 3% 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 fastin g glucose are at high risk of recurrent coronary events that can be substan tially reduced by pravastatin treatment.