Background In patients with coronary heart disease and a broadrange of cholesterol levels, cholesterol-lowering therapy reducesthe risk of coronary events, but the effects on mortality fromcoronary heart disease and overall mortality have remained uncertain.
Methods In a double-blind, randomized trial, we compared theeffects of pravastatin (40 mg daily) with those of a placeboover a mean follow-up period of 6.1 years in 9014 patients whowere 31 to 75 years of age. The patients had a history of myocardialinfarction or hospitalization for unstable angina and initialplasma total cholesterol levels of 155 to 271 mg per deciliter.Both groups received advice on following a cholesterol-loweringdiet. The primary study outcome was mortality from coronaryheart disease.
Results Death from coronary heart disease occurred in 8.3 percentof the patients in the placebo group and 6.4 percent of thosein the pravastatin group, a relative reduction in risk of 24percent (95 percent confidence interval, 12 to 35 percent; P<0.001). Overall mortality was 14.1 percent in the placebo groupand 11.0 percent in the pravastatin group (relative reductionin risk, 22 percent; 95 percent confidence interval, 13 to 31percent; P<0.001). The incidence of all cardiovascular outcomeswas consistently lower among patients assigned to receive pravastatin;these outcomes included myocardial infarction (reduction inrisk, 29 percent; P<0.001), death from coronary heart diseaseor nonfatal myocardial infarction (a 24 percent reduction inrisk, P<0.001), stroke (a 19 percent reduction in risk, P=0.048),and coronary revascularization (a 20 percent reduction in risk,P<0.001). The effects of treatment were similar for all predefinedsubgroups. There were no clinically significant adverse effectsof treatment with pravastatin.
Conclusions Pravastatin therapy reduced mortality from coronaryheart disease and overall mortality, as compared with the ratesin the placebo group, as well as the incidence of all prespecifiedcardiovascular events in patients with a history of myocardialinfarction or unstable angina who had a broad range of initialcholesterol levels.
Source Information
Address reprint requests to the National Health and Medical Research Council Clinical Trials Centre, Mallett St. Campus, University of Sydney, NSW 2006, Australia. Drs. Andrew Tonkin and R. John Simes assume responsibility for the overall content of the manuscript.
Unstable Angina Pectoris
Colwell N. S., Buckley B. M., Murphy M. B., Shavelle D. M., Wuthrich D. A., Srivathsan K., Showalter J. C., Dieter R. S., Yeghiazarians Y., Stone P. H.
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Full Text
N Engl J Med 2000;
342:1676-1678, Jun 1, 2000.
Correspondence
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