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

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.