Prevention of Cardiovascular Events and Death with Pravastatin in Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol Levels
Open accessAbstract
BACKGROUND: In patients with coronary heart disease and a broad range of cholesterol levels, cholesterol-lowering therapy reduces the risk of coronary events, but the effects on mortality from coronary heart disease and overall mortality have remained uncertain. METHODS: In a double-blind, randomized trial, we compared the effects of pravastatin (40 mg daily) with those of a placebo over a mean follow-up period of 6.1 years in 9014 patients who were 31 to 75 years of age. The patients had a history of myocardial infarction or hospitalization for unstable angina and initial plasma total cholesterol levels of 155 to 271 mg per deciliter. Both groups received advice on following a cholesterol-lowering diet. The primary study outcome was mortality from coronary heart disease. RESULTS: Death from coronary heart disease occurred in 8.3 percent of the patients in the placebo group and 6.4 percent of those in the pravastatin group, a relative reduction in risk of 24 percent (95 percent confidence interval, 12 to 35 percent; P<0.001). Overall mortality was 14.1 percent in the placebo group and 11.0 percent in the pravastatin group (relative reduction in risk, 22 percent; 95 percent confidence interval, 13 to 31 percent; P<0.001). The incidence of all cardiovascular outcomes was consistently lower among patients assigned to receive pravastatin; these outcomes included myocardial infarction (reduction in risk, 29 percent; P<0.001), death from coronary heart disease or nonfatal myocardial infarction (a 24 percent reduction in risk, 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 predefined subgroups. There were no clinically significant adverse effects of treatment with pravastatin. CONCLUSIONS: Pravastatin therapy reduced mortality from coronary heart disease and overall mortality, as compared with the rates in the placebo group, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.
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A large body of evidence shows that statin strategies produce similar LDL cholesterol lowering and relative cardiovascular risk reduction in people with and without type 2 diabetes.
“A large body of evidence indicates that statin-based strategies convey similar LDL-C lowering and relative cardiovascular risk reduction in patients with and those without T2DM.102–112”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [103]
Trial evidence confirms that statin therapy adds benefit in primary and secondary prevention of coronary artery disease.
“Although healthy lifestyle habits remain a cornerstone of T2DM management, trial data have confirmed the additional benefits of statin therapy in the primary and secondary prevention of CAD.13,102–112”
From Clinical management of stable coronary artery disease in patients with type 2 diabetes mellitus: a scientific statement from the American Heart Association (2020) · cites this paper as [103]
Routine early use of high-intensity statin therapy is associated with rapid and sustained clinical benefits.
“Data from RCTs and meta-analyses indicate that routine early use of high-intensity statin therapy is associated with rapid and sustained clinical benefits [438-442].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [442]
Pooling of RCT results suggested that cholesterol lowering with statin treatment reduced incident heart failure by 9-45% in patients with CAD.
“Pooling of results from RCTs suggested that cholesterol lowering with statin treatment reduced incident HF by 9-45% in patients with CAD.22,180”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [22]
Pooling results from RCTs suggested that cholesterol lowering with statin treatment reduced incident HF by 9-45% in patients with CAD.
“Pooling of results from RCTs suggested that cholesterol lowering with statin treatment reduced incident HF by 9-45% in patients with CAD. 368,369”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [369]
Pooling results from randomized controlled trials suggested that cholesterol lowering with statin treatment reduced incident heart failure by 9-45% in patients with coronary artery disease.
“Pooling of results from RCTs suggested that cholesterol lowering with statin treatment reduced incident HF by 9e45% in patients with CAD.368,369”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [369]
The REACH registry demonstrated that approximately 16% of registered cases were complicated with two or more ASCVD conditions.
“It was demonstrated in the REACH registry, a registry study on patients with ASCVD or overlapping risks factors for ASCVD, that approximately 16% registered cases are complicated with two or more ASCVD757).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [757]
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- Authors
- The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1998-11-05
- Volume
- 339
- Issue
- 19
- Pages
- 1349-1357
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W38523360
- Cited by
- 5,261
- References
- 21
- Citations by year
- 2026: 19 · 2025: 24 · 2024: 57 · 2023: 53 · 2022: 60 · 2021: 58 · 2020: 72 · 2019: 82 · 2018: 81 · 2017: 94 · 2016: 114 · 2015: 111 · 2014: 118 · 2013: 167 · 2012: 147
- FWCI
- 312.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- pravastatin, coronary artery disease, statin therapy, cholesterol-lowering therapy, cardiovascular mortality, myocardial infarction, unstable angina, stroke, coronary revascularization, total cholesterol, secondary prevention, lipid-lowering diet
- MeSH terms
- Adult, Aged, Anticholesteremic Agents, Cardiovascular Diseases, Coronary Disease, Double-Blind Method, Female, Humans, Lipids, Male, Middle Aged, Mortality, Myocardial Infarction, Risk, Incidence, Pravastatin
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