Effects of pravastatin in 3260 patients with unstable angina: results fromthe LIPID study

Background The LIPID study is a major trial of secondary prevention of coro nary-heart-disease events that includes hospital admission,with unstable an gina (as well as myocardial infarction) as a qualifying event. In this subs tudy of LIPID, we compared subsequent cardiovascular risks and the effects of pravastatin in patients with previous unstable angina or previous myocar dial infarction. Methods 3260 patients diagnosed with unstable angina and 5754 with acute my ocardial infarction 3-36 months previously were randomly assigned 40 mg pra vastatin daily or placebo over a mean of 6.0 years. The risk reduction of a range of cardiovascular events was estimated by means of the hazard ratio in Cox's proportional hazards model. Findings Among patients assigned placebo, survival in the two diagnosis gro ups was similar. The relative risk reduction for mortality with pravastatin was 20.6% in the myocardial infarction group and 26.3% in the unstable ang ina group (p=0.55). Pravastatin significantly reduced the rates of all pres pecified coronary endpoints in the myocardial infarction group. In patients with previous unstable angina, coronary heart disease mortality, total mor tality, myocardial infarction, a need for coronary revascularisation, the n umber of admissions to hospital, and the number of days in hospital were si gnificantly lower with pravastatin. Overall, hospital admission for unstabl e angina was the most common endpoint (24.6% of the placebo group; 22.3% of the pravastatin group). Interpretation Patients who have survived acute myocardial infarction or un stable angina have a similar long-term prognosis, a high occurrence of subs equent unstable angina, and benefit similarly from therapy with pravastatin .