Cited by 313Lipoproteins and Cardiovascular HealthDiabetes, Cardiovascular Risks, and LipoproteinsCancer, Lipids, and Metabolism

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Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose

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Keech, Anthony, Colquhoun, David, Best, James, Kirby, Adrienne, Simes, R. John, Hunt, David, Hague, Wendy, Beller, Elaine, Arulchelvam, Manjula, Baker, Jennifer, Tonkin, Andrew, for the LIPID Study Group·2003·Diabetes Care

DOI 10.2337/diacare.26.10.2713

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Abstract

OBJECTIVE—Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed. RESEARCH DESIGN AND METHODS—The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31–75 years with CHD and total cholesterol 4.0–7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG). RESULTS—In patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P < 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P = 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P < 0.008) in patients with diabetes and from 45.7 to 37.1% (26%, P = 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, CI 7–61%, P = 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, CI −9 to 69%, P = 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients. CONCLUSIONS—Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD.

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Authors: Keech, A., Colquhoun, D., Best, J., Kirby, A., Simes, R. J., Hunt, D., Hague, W., Beller, E., Arulchelvam, M., Baker, J., Tonkin, A., & for the LIPID Study Group
Affiliations: The University of Sydney (AU)
Wesley Hospital (AU)
St Vincent's Hospital Melbourne (AU)
The Royal Melbourne Hospital (AU)
National Heart Foundation of Australia (AU)
ORCID: Keech, Anthony
Best, James
Kirby, Adrienne
Simes, R. John
Hunt, David
Beller, Elaine
Tonkin, Andrew
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2003-10-01
Volume: 26
Issue: 10
Pages: 2713-2721
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/diacare.26.10.2713
OpenAlex: W2086139919
Cited by: 313
References: 36
Citations by year: 2026: 4 · 2024: 3 · 2023: 5 · 2022: 6 · 2021: 5 · 2020: 3 · 2019: 11 · 2018: 7 · 2017: 6 · 2016: 11 · 2015: 13 · 2014: 14 · 2013: 21 · 2012: 14
FWCI: 26.36
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Griffith Research Online (submittedVersion)
Funders: Bristol-Myers Squibb
National Heart Foundation of Australia
Medical Research Council
National Health and Medical Research Council
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
Keywords: pravastatin, secondary prevention, cardiovascular events, diabetes mellitus, impaired fasting glucose, coronary artery disease, myocardial infarction, stroke, LIPID trial, cholesterol-lowering therapy, statins, cardiovascular risk reduction, hypercholesterolemia, diabetes incidence, nonfatal myocardial infarction, cardiovascular hospitalization
MeSH terms: Adult, Aged, Angina, Unstable, Anticholesteremic Agents, Blood Glucose, Cardiovascular Diseases, Coronary Artery Disease, Diabetes Mellitus, Type 2, Fasting, Female, Follow-Up Studies, Humans, Hyperlipidemias, Male, Middle Aged, Myocardial Infarction, Risk Factors, Treatment Outcome, Pravastatin, Glucose Intolerance, Stroke, Coronary Restenosis

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Secondary Prevention of Cardiovascular Events With Long-Term Pravastatin in Patients With Diabetes or Impaired Fasting Glucose

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