A Comparison of Low Versus Standard Dose Pravastatin Therapy for the Prevention of Cardiovascular Events in the Elderly : The Pravastatin Anti-atherosclerosis Trial in the Elderly (PATE)
Open accessAbstract
Treatment with low drug doses is generally recommended in the elderly. However, the efficacy of low dose 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitor treatment in elderly hypercholesterolemic patients has never been examined. Therefore, we compared the effect of low-dose with standard dose pravastatin, an HMG CoA reductase inhibitor, on the incidence of cardiovascular events (CVEs) in elderly patients with hypercholesterolemia in a randomized prospective trial. Subjects aged > or = 60 years (73 +/- 6 years) with serum total cholesterol (TC) levels of 220-280 mg/dL were randomized to the low-dose (groupL, 5 mg/day; n=334) or standard dose (groupS, 10-20mg/day; n= 331). Baseline TC levels were similar in the 2 groups (253 +/-15 mg/dL). Patients were followed for 3-5 years (mean 3.9 years). TC levels decreased from baseline by 11-13% in group L and by 15-17% in groupS. TC levels at 1 year in S and L group were 209 +/- 2 mg/ dL (16 +/- 1% decrease) and 221+/- 2 mg/dL (12 +/- 1% decrease), respectively. Forty two and 29 CVEs occurred in group L and S, respectively. The incidence of CVEs was significantly lower in group S than in group L (P = 0.046, generalized Wilcoxon test; P = 0.096, log-rank test). The risk ratio for group S compared with group L was 0.674 (95% confidence interval: 0.423-1.074). Subgroup analyses suggested that the difference in the incidence of CVEs between the 2 groups was more clear in subjects without diabetes mellitus, with TC levels of < 253 mg/dL, and with TG levels of > or = 133 mg/dL. The incidence of CVEs in group S was significantly lower than that in group L in subjects without both diabetes mellitus and previous cardiovascular disease (P = 0.026, generalized Wilcoxon test; P = 0.032, log rank test). These findings suggest that standard-dose pravastatin (10-20 mg/day) is more effective in reducing the incidence of CVEs in the elderly than low dose pravastatin (5 mg/ day), especially in nondiabetic elderly patients with mild hypercholesterolemia or previous cardiovascular disease.
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Large-scale Japanese clinical studies showed that treating hyper-LDL cholesterolemia decreased CAD occurrence.
“Large-scale clinical studies conducted in Japan have also reported similar results41–44), in which it was evident that the occurrence of CAD in the Japanese subjects decreased as a result of treating the hyper-LDL cholesterolemia.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [43]
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高齢者虚血性心疾患 : 最近の治療の変遷と問題点(4. 高齢者の循環器疾患 : 何をどこまで治療するか)(<特集>第68回日本循環器学会学術集会)
Kitaoka, H., Takata, J., & Doi, Y. (2004) · Journal of JCS Cardiologists · doi:10.1253/jjcsc.12.2_241
Santos, L. E. G., Nevado, J. B., de la Paz, E. M. C. C. –., Abrahan, L. L., Aman, A. Y. C. L., Llanes, E. J. B., Magno, J. D. A., Ona, D. I. D., Punzalan, F. E. R., Reganit, P. F. M., et al. (2021) · Acta Medica Philippina · doi:10.47895/amp.vi0.2353
Yokote, K. (2011) · Nippon Ronen Igakkai Zasshi Japanese Journal of Geriatrics · doi:10.3143/geriatrics.48.250
The Promise of Primary Prevention in Older Adults
Khan, S. U. (2023) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.005
Diabetes: prevention of cardiovascular events.
Sigal, R. J., Malcolm, J., & Arnaout, A. (2006) · PubMed Central
- Authors
- Ito, H., Ouchi, Y., Ohashi, Y., Saito, Y., Ishikawa, T., Nakamura, H., & Orimo, H.
- Affiliations
- Tokyo Metropolitan Geriatric Hospital (JP)
- The University of Tokyo (JP)
- National Defense Medical College (JP)
- Venue
- Journal of Atherosclerosis and Thrombosis
- Publisher
- Japan Atherosclerosis Society
- Published
- 2001
- Volume
- 8
- Issue
- 2
- Pages
- 33-44
- ISSN
- 1340-3478 (ISSN-L)
- 1880-3873
- OpenAlex
- W2045439469
- Cited by
- 73
- References
- 28
- Citations by year
- 2025: 1 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 2 · 2018: 3 · 2017: 3 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Atherosclerosis and Thrombosis (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Lipids, and Metabolism
- Keywords
- pravastatin, low-dose statin therapy, statins, hypercholesterolemia, elderly patients, cardiovascular events, cholesterol lowering, triglycerides, diabetes mellitus, cardiovascular disease, statin dose comparison, atherosclerosis prevention, cardiovascular risk stratification
- MeSH terms
- Aged, Aged, 80 and over, Anticholesteremic Agents, Arteriosclerosis, Cardiovascular Diseases, Cholesterol, Female, Humans, Hypercholesterolemia, Male, Middle Aged, Prospective Studies, Risk Factors, Safety, Triglycerides, Pravastatin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Diabetes Complications
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