EFFECT OF PRAVASTATIN ON CARDIOVASCULAR EVENTS IN OLDER PATIENTS WITHMYOCARDIAL-INFARCTION AND CHOLESTEROL LEVELS IN THE AVERAGE RANGE - RESULTS OF THE CHOLESTEROL AND RECURRENT EVENTS (CARE) TRIAL
Sj. Lewis et al., EFFECT OF PRAVASTATIN ON CARDIOVASCULAR EVENTS IN OLDER PATIENTS WITHMYOCARDIAL-INFARCTION AND CHOLESTEROL LEVELS IN THE AVERAGE RANGE - RESULTS OF THE CHOLESTEROL AND RECURRENT EVENTS (CARE) TRIAL, Annals of internal medicine, 129(9), 1998, pp. 681
Background: A majority of all myocardial infarctions occur in patients
who are 65 years of age or older and have average cholesterol levels,
but little information is available on whether cholesterol lowering i
n such patients reduces the rate of recurrent cardiovascular disease.
Objective: To determine whether pravastatin reduces the rate of recurr
ent cardiovascular events in older patients. Design: Subset analysis o
f a randomized, controlled trial. Setting: 80 hospitals and affiliates
in the United States and Canada. Patients: 1283 patients aged 65 to 7
5 years who had had myocardial infarction and had a plasma total chole
sterol level less than 6.2 mmol/L (240 mg/dL) and a low-density lipopr
otein cholesterol level of 3.0 to 4.5 mmol/L (115 to 174 mg/dL). Inter
vention: Pravastatin, 40 mg/d, or placebo. Measurements: Five-year eve
nt rates of major coronary events (coronary death, nonfatal myocardial
infarction, angioplasty, or bypass surgery) and stroke. Results: Majo
r coronary events occurred in 28.1% of placebo recipients and 19.7% of
pravastatin recipients (difference, 9.0 percentage points [95% CI, 4
to 13 percentage points]; relative risk reduction, 32%; P < 0.001). Co
ronary death occurred in 10.3% of the placebo group and in 5.8% of the
pravastatin group (difference, 4.6 percentage points [CI, 1.9 to 6.5
percentage points]; relative risk reduction, 45%; P = 0.004). Stroke i
ncidence was 7.3% in the placebo group and 4.5% in the pravastatin gro
up (absolute reduction, 2.9 percentage points [CI, 0.3 to 4.5 percenta
ge points]; relative reduction, 40%; P = 0.03). The numbers of older p
atients needed to treat for 5 years were 11 (CI, 8 to 24) to prevent a
major coronary event and 22 (CI, 15 to 53) to prevent a coronary deat
h. For every 1000 older patients treated, 225 cardiovascular hospitali
zations would be prevented compared with 121 hospitalizations in 1000
younger patients. Conclusions: In older patients with myocardial infar
ction and cholesterol levels in the average range, pravastatin is asso
ciated with a clinically important reduction in risk for major coronar
y events and stroke. Given the high cardiovascular event rate in older
patients, the potential for absolute benefit in this age group is sub
stantial.