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Cited by 986Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsAcute Myocardial Infarction Research

Cardiovascular Events and Their Reduction With Pravastatin in Diabetic and Glucose-Intolerant Myocardial Infarction Survivors With Average Cholesterol Levels: Subgroup Analyses in the Cholesterol And Recurrent Events (CARE) Trial

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Goldberg, Ronald B., Mellies, Margot J., Sacks, Frank M., Moyé, Lemuel A., Howard, Barbara V., Howard, William James, Davis, Barry R., Cole, Thomas G. +2 more·1998·Circulation
DOI 10.1161/01.cir.98.23.2513
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Abstract

Background —Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. Methods and Results —The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes—136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides—were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% ( P =0.05) and 23% ( P <0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% ( P =0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, –50%, P =0.05 for nonfatal MI). Conclusions —Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

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  • Subgroup analyses of people with diabetes in larger trials and trials in people with diabetes showed significant primary and secondary prevention of ASCVD events and CHD death in people with diabetes.

    “Subgroup analyses of people with diabetes in larger trials (101-105) and trials in people with diabetes (106,107) showed significant primary and secondary prevention of ASCVD events and CHD death in people with diabetes.”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [103]

    The Results report a significant reduction in a composite of recurrent coronary events among patients with diabetes, supporting secondary prevention. But this trial studied myocardial infarction survivors, not primary prevention, and the Results explicitly report no reduction in CHD death in the diabetes group. No page number is available in our copy. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Subgroup analyses of people with diabetes in larger trials and trials in people with diabetes showed significant primary and secondary prevention of ASCVD events and CHD death in people with diabetes.

    “Subgroup analyses of people with diabetes in larger trials (94–98) and trials in people with diabetes (99,100) showed significant primary and secondary prevention of ASCVD events and coronary heart disease (CHD) death in people with diabetes.”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [96]

    The Results (page not supplied) report a significant 25% reduction in a composite of recurrent coronary events among patients with diabetes, supporting secondary prevention. But CARE studied myocardial infarction survivors, not primary prevention, and the Results say CHD death did not decline in the diabetes subgroup. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Subgroup analyses of people with diabetes in larger trials and trials in people with diabetes showed significant primary and secondary prevention of ASCVD events and CHD death.

    “Subgroup analyses of people with diabetes in larger trials (92 -96) and trials in people with diabetes (97,98) showed signi fi cant primary and secondary prevention of ASCVD events and CHD death in people with diabetes.”

    From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [94]

  • Subanalyses of diabetic subgroups of larger trials and trials specifically in subjects with diabetes showed significant primary and secondary prevention of CVD events ± CHD deaths in diabetic populations.

    “Subanalyses of diabetic subgroups of larger trials (186–190) and trials specifically in subjects with diabetes (191,192) showed significant primary and secondary prevention of CVD events ± CHD deaths in diabetic populations.”

    From Standards of Medical Care in Diabetes—2009 (2009) · cites this paper as [188]

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Research works printed but not linked: 20

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Authors
Goldberg, R. B., Mellies, M. J., Sacks, F. M., Moyé, L. A., Howard, B. V., Howard, W. J., Davis, B. R., Cole, T. G., Pfeffer, M. A., & Braunwald, E.
Affiliations
  • Brigham and Women's Hospital (US)
  • From the University of Miami School of Medicine, Miami, Fla (R.B.G.); the University of Texas School of Public Health, Houston, Tex (L.A.M., B.R.D.); Bristol Myers Squibb, Princeton, NJ (M.J.M.); Medlantic Research Institute, Washington, DC (B.V.H.); Washington Hospital Center, Washington, DC (W.J.H.); Washington University, St. Louis, Mo (T.G.C.); and Brigham and Women’s Hospital and Harvard Medical School, Boston, Mass (F.M.S., M.A.P., E.B.).
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1998-12-08
Volume
98
Issue
23
Pages
2513-2519
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/01.cir.98.23.2513
OpenAlex
W2115728877
Cited by
986
References
3
Citations by year
2026: 1 · 2025: 5 · 2024: 4 · 2023: 7 · 2022: 5 · 2021: 4 · 2020: 8 · 2019: 7 · 2018: 9 · 2017: 14 · 2016: 8 · 2015: 19 · 2014: 23 · 2013: 29 · 2012: 23
FWCI
57.80
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
Keywords
pravastatin, lipid-lowering therapy, diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, myocardial infarction survivors, coronary artery disease, recurrent cardiovascular events, LDL cholesterol lowering, revascularization, CARE trial
MeSH terms
Adult, Aged, Anticholesteremic Agents, Cholesterol, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Pravastatin, Glucose Intolerance, Diabetes Complications

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