Copyright © 2002 by the European Society of Cardiology.
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Effects of pravastatin on mortality in patients with and without coronary heart disease across a broad range of cholesterol levels. The Prospective Pravastatin Pooling project
a University of Sydney, Sydney, Australia
b Wake Forest University, Winston-Salem, NC, U.S.A.
c Brigham and Women's Hospital, Boston, Mass. U.S.A.
d University of Texas School of Public Health, Houston, Texas
e University of Glasgow, Glasgow, Scotland
f National Heart Foundation, Melbourne, Australia
revised May 1, 2001; accepted May 2, 2001
Abstract
Aims To assess the effects of pravastatin on all-cause mortality and cause-specific mortality and to compare the effects for patients with prior coronary heart disease with those for patients without, using pooled data from the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study, the Cholesterol and Recurrent Events (CARE) study, and the West of Scotland Coronary Prevention Study (WOSCOPS).
Methods and Results 13173 patients with coronary heart disease and 6595 men with elevated cholesterol and no prior coronary disease received pravastatin, 40mg daily, or placebo for an average of 5 to 6 years. Data were analysed according to a pre-specified, published protocol. For all three trials combined, the mortality among patients assigned pravastatin was significantly lower, at 7·9%, than the 9·8% among those assigned placebo, a relative risk reduction of 20% (95% confidence interval (CI) 12–27%, P<0·0001). Active treatment was associated with a reduction in coronary mortality (24%, 95% CI 14–33%). Larger reductions in absolute risk were estimated in those with prior coronary heart disease than in those without.
Conclusion Treatment with pravastatin over 5 years reduces all-cause mortality and coronary mortality in patients with and those without a history of coronary heart disease. The size of the benefit was related principally to the baseline risk.
Key Words: Lipids, mortality, meta-analysis, clinical trial, coronary disease, cholesterol
f1 Correspondence: Professor John Simes, NHMRC Clinical Trials Centre, Mallett Street Campus, University of Sydney, NSW 2006, Australia.
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