Benefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: Results from the LIPID trial

Background: The effect of cholesterol-lowering therapy on death from corona ry heart disease in older patients with previous coronary heart disease and average cholesterol levels is uncertain. Objective: To compare the relative and absolute effects of pravastatin on c ardiovascular disease outcomes in patients with coronary heart disease who are 65 years of age or older with those in patients 31 to 64 years of age. Design: Subgroup analysis of a randomized, placebo-controlled trial. Setting: 87 centers in Australia and New Zealand. Patients: 3514 patients 65 to 75 years of age, chosen from among 9014 patie nts with previous myocardial infarction or unstable angina and a baseline p lasma cholesterol level of 4.0 to 7.0 mmol/L (155 to 271 mg/dl). Intervention: Pravastatin, 40 mg/d, or placebo. Measurements: Major cardiovascular disease events over 6 years. Results: older patients were at greater risk than younger patients (31 to 6 4 years of age) for death (20.6% vs. 9.8%), myocardial infarction (11.4% vs . 9.5%), unstable angina (26.7% vs. 23.2%), and stroke (6.7% vs. 3.1%) (all P < 0.001). Pravastatin reduced the risk for all cardiovascular disease ev ents, and similar relative effects were observed in older and younger patie nts. In patients 65 to 75 years of age, pravastatin therapy reduced mortali ty by 21% (CI, 7% to 32%), death from coronary heart disease by 24% (CI, 7% to 38%), coronary heart disease death or nonfatal myocardial infarction by 22% (CI, 9% to 34%), myocardial infarction by 26% (CI, 9% to 40%), and str oke by 12% (CI, -15% to 32%). For every 1000 older patients treated over 6 years, pravastatin prevented 45 deaths, 33 myocardial infarctions, 32 unsta ble angina events, 34 coronary revascularization procedures, 13 strokes, or 133 major cardiovascular events, compared with 22 deaths and 107 major car diovascular events per 1000 younger patients. Among older patients, the num bers needed to treat were 22 (CI, 17 to 36) to prevent one death from any c ause, 35 (CI, 24 to 67) to prevent one death from coronary heart disease, a nd 21 (CI, 17 to 31) to prevent one coronary heart disease death or nonfata l myocardial infarction. Conclusions: In older patients with coronary heart disease and average or m oderately elevated cholesterol levels, pravastatin therapy reduced the risk for all major cardiovascular events and all-cause mortality. Since older p atients are at greater risk than younger patients for these events, the abs olute benefit of treatment is significantly greater in older patients.