Copyright © 2004 by the European Society of Cardiology.
Clinical research
Effects of pravastatin on coronary events in 2073 patients with low levels of both low-density lipoprotein cholesterol and high-density lipoprotein cholesterol: results from the LIPID study
a Wesley Medical Centre, University of Queensland, 40 Chasely Street, Auchenflower, Qld. 4066, Australia
b NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
c Royal Melbourne Hospital, Melbourne, Australia
d University of Oxford, Oxford, UK
e Green Lane Hospital, Auckland, New Zealand
f University of Adelaide, Adelaide, Australia
g Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Received September 17, 2003;
revised March 1, 2004;
accepted March 18, 2004
* Corresponding author. Tel.: +61-7-3371-9477/2-9562-5000; fax: +61-7-3870-1490/2-9565-1863
E-mail address: D.Colquhoun{at}mailbox.uq.edu.au
See page 716 for the editorial comment on this article1
Aims Fibrates or nicotinic acid are usually recommended for secondary prevention of coronary heart disease in patients with low plasma levels of both low-density lipoprotein cholesterol (LDL-C) 
140 mg/dL (3.6 mmol/L) and high-density lipoprotein cholesterol (HDL-C) 40 mg/dL (1.03 mmol/L). The LIPID trial, a randomised, placebo-controlled trial in 9014 patients at 87 centres in Australia and New Zealand, provided an opportunity to investigate the effects of an HMG-CoA reductase inhibitor in patients with low LDL-C and low HDL-C.
Methods and results Participants in this post hoc substudy were 2073 patients aged 31–75 years with baseline LDL-C 140 mg/dL (3.6 mmol/L), HDL-C 40 mg/dL (1.03 mmol/L), and triglyceride 300 mg/dL (3.4 mmol/L). The relative risk reduction with pravastatin treatment was 27% for major coronary events (95% CI 8–42%), 27% for coronary heart disease mortality (95% CI 0–47%), 21% for all-cause mortality (95% CI 0–38%), and 51% for stroke (95% CI 24–69%). The number needed to treat to prevent a major coronary event over 6 years was 22.
Conclusions Treatment with pravastatin in patients with both low LDL-C and low HDL-C significantly reduced major coronary events, stroke, and all-cause mortality. The level of HDL-C is crucial to the risk of recurrent CHD events and, consequently, the benefit of lowering LDL-C.
Key Words: Statin • Fibrate • Low-density lipoprotein cholesterol • High-density lipoprotein cholesterol • Clinical trial substudy
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