Reduction in coronary events during treatment with pravastatin

• Published in: The American journal of cardiology 1995-09, Vol.76 (9), p.60C-63C
• Main Authors: Furberg, Curt D., Pitt, Bertram, Byington, Robert P., Park, Jong-Soon, McGovern, Mark E., The PLAC I and PLAC II Investigators
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cardiovascular disease; Drug therapy; General and cellular metabolism. Vitamins; Medical research; Medical sciences; Pharmacology. Drug treatments
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(99)80472-X

The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, or statins, are more efficacious than older lipid-lowering agents and there-fore may be more effective in reducing the incidence of coronary events. The objective of this prespecified analysis was to examine in coronary patients the effect of the lipid-lowering agent pravastatin on 3-year rates of coronary event incidence, all-cause mortality, and nonfatal myocardial infarction (M1), and to determine whether any observed benefit was also evident in patients 265 years of age. The design of this analysis was to pool the data from 2 concurrent 3-year placebo-controlled clinical trials of pravastatin monotherapy in coronary patients (Pravastatin Limitation of Atherosclerosis in the Coronary Arteries [PLAC I] and the Pravastatin, Lipids, and Atherosclerosis in the Carotid Arteries [PLAC II]). This pooled database included 559 coronary patients with moderately elevated levels of low density lipoprotein cholesterol (between the 60th and 90th percentiles for age and gender in the United States). Over the 3 years of follow-up, use of pravastatin was associated with a 55% reduction in coronary incidence (p = 0.014). Pravastatin was also associated with a 67% reduction in nonfatal M1 (p = 0.006). Eleven placebo patients died over the 3 years of follow-up compared with 7 in the pravastatin groups (a 40% reduction). Among older patients (age ≥65 years), pravastatin therapy was associated with a 79% reduction in coronary event incidence (95% confidence interval [CI] 33–100%) and with a 86% reduction in nonfatal myocardial infarction (CI, 35–100%). These results provide strong evidence that pravastatin prevents recurrent clinical events in coronary patients, including those ≥65 years of age.