Pravastatin prevents clinical events in revascularized patients with average cholesterol concentrations

OBJECTIVES This analysis was carried out to determine if revascularized pat ients derive benefit from the 3-hydroxy-3 methylglutaryl coenzyme A (HMG-Co A) reductase inhibitor pravastatin. BACKGROUND The HMG-CoA reductase inhibitors result in substantial reduction s in serum cholesterol and stabilization of atherosclerotic plaques in pati ents with coronary artery disease. METHODS Pravastatin was found to reduce clinical cardiovascular events in t he Cholesterol and Recurrent Events (CARE) trial consisting of 4,159 patien ts with a documented myocardial infarction and an average cholesterol level (mean 209 mg/dl and all <240 mg/dl). ri total of 2,245 patients underwent coronary revascularization before randomization including 1,154 patients wi th percutaneous transluminal coronary angioplasty (PTCA) alone, 876 patient s with coronary artery bypass graft (CABG) alone, and 215 patients with bot h procedures. Clinical events in revascularized patients were compared betw een patients on placebo and on pravastatin. RESULTS In the 2,245 patients who had undergone revascularization, the prim ary endpoint of coronary heart disease death or nonfatal myocardial infarct ion (MI) was reduced by 4.1% with pravastatin (relative risk [RR] reduction 36%, 95%, confidence interval [CI] 17 to 51, p = 0.001). Fatal or nonfatal MI was reduced by 3.3% (RR reduction 39%, 95% CI 16 to 55, p = 0.002), pos trandomization repeat revascularization was reduced by 2.6% (RR reduction 1 8%, 95% CI: 1 to 33, p = 0.068) and stroke was reduced by 1.5% (RR reductio n 39%, 95% CI 3 to 62, p = 0.037) with pravastatin. Pravastatin was benefic ial in both the 1,154 PTCA patients and in the 1,091 CABG patients who, had undergone revascularization before randomization. CONCLUSIONS Pravastatin reduced clinical events in revascularized postinfar ction patients with average cholesterol levels. This therapy was well toler ated and its use should be considered in most patients following coronary r evascularization. (C) 1999 by the American College of Cardiology.