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November 1, 1998Annals of Internal Medicine

Effect of Pravastatin on Cardiovascular Events in Older Patients with Myocardial Infarction and Cholesterol Levels in the Average Range: Results of the Cholesterol and Recurrent Events (CARE) Trial

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Why the study?

Does pravastatin reduce the rate of recurrent cardiovascular events in older patients with prior myocardial infarction and average cholesterol levels?

Population

1,283 patients aged 65 to 75 years who had had myocardial infarction and had a plasma total cholesterol…

Comparison

Pravastatin 40 mg/d vs Placebo

Design

RCT, Randomized, Placebo-controlled

Follow-up

5 years

Authors

SLSandra J. LewisLegacy Health

Discussion

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Implication

Supports pravastatin for secondary prevention in older post-MI patients with average cholesterol; extends statin benefit to this subgroup.

Key Points

  • To determine whether pravastatin reduces recurrent cardiovascular events and stroke in older patients who have had a myocardial infarction and maintain average cholesterol levels.
  • Subset analysis of a randomized, controlled trial conducted across 80 hospitals and affiliates in the United States and Canada.
  • Included 1283 patients aged 65 to 75 years with prior myocardial infarction, plasma total cholesterol < 6.2 mmol/L (240 mg/dL), and LDL cholesterol between 3.0 and 4.5 mmol/L (115 to 174 mg/dL).
  • Assigned patients to pravastatin (40 mg/d) or placebo, tracking 5-year event rates for major coronary events (coronary death, nonfatal myocardial infarction, angioplasty, or bypass surgery) and stroke.
  • Major coronary events occurred in 19.7% of pravastatin recipients compared with 28.1% of placebo recipients (difference, 9.0 percentage points [95% CI, 4 to 13 percentage points]; relative risk reduction, 32%; P < 0.001).
  • Coronary death occurred in 5.8% of the pravastatin group versus 10.3% of the placebo group (difference, 4.6 percentage points [95% CI, 1.9 to 6.5 percentage points]; relative risk reduction, 45%; P = 0.004).
  • Stroke incidence was 4.5% with pravastatin compared with 7.3% with placebo (absolute reduction, 2.9 percentage points [95% CI, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03).

Structured PICO

Does pravastatin reduce the rate of recurrent cardiovascular events in older patients with prior myocardial infarction and average cholesterol levels?

P
Population
1,283 patients aged 65 to 75 years who had had myocardial infarction and had a plasma total cholesterol level less than 6.2 mmol/L (240 mg/dL) and a low-density lipoprotein cholesterol level of 3.0 to 4.5 mmol/L (115 to 174 mg/dL).
I
Intervention
Pravastatin 40 mg/d
C
Comparator
Placebo
O
Outcome
Five-year event rates of major coronary events (composite of coronary death, nonfatal myocardial infarction, angioplasty, or bypass surgery) and strokecomposite

In older patients with prior myocardial infarction and average cholesterol levels, pravastatin 40 mg/d significantly reduces the risk of major coronary events and stroke over 5 years.

Cite This Study

Sandra J. Lewis (1998) studied this question.

synapsesocial.com/papers/6a7dfecba76b9ebabb045e5chttps://doi.org/10.7326/0003-4819-129-9-199811010-00002

Topics

Women and heart disease
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Clarifying the Direct Relation between Total Cholesterol Levels and Death from Coronary Heart Disease in Older Persons1997 · 265 citations
  2. 241‐Month Follow‐Up of Risk Factors Correlated With New Coronary Events in 708 Elderly Patients1989 · 68 citations
  3. 3Recent Age-Related Trends in the Use of Thrombolytic Therapy in Patients Who Have Had Acute Myocardial Infarction1996 · 130 citations
  4. 4Cholesterol-Lowering Therapy in Women and Elderly Patients With Myocardial Infarction or Angina Pectoris1997 · 511 citations
  5. 5Primary Prevention of Acute Coronary Events With Lovastatin in Men and Women With Average Cholesterol Levels1998 · 5,296 citations