The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels

Frank M. Sacks, Marc A. Pfeffer, Lemuel A. Moye, Jean L. Rouleau, John D. Rutherford, Thomas G. Cole, Lisa Brown, J. Wayne Warnica, J. Malcolm O Arnold, Chuan Chuan Wun, Barry R. Davis, Eugene Braunwald

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Abstract

Background: In patients with high cholesterol levels, lowering the cholesterol level reduces the risk of coronary events, but the effect of lowering cholesterol levels in the majority of patients with coronary disease, who have average levels, is less clear. Methods: In a double-blind trial lasting five years, we administered either 40 mg of pravastatin per day or placebo to 4159 patients (3583 men and 576 women) with myocardial infarction who had plasma total cholesterol levels below 240 mg per deciliter (mean, 209) and low-density lipoprotein (LDL) cholesterol levels of 115 to 174 mg per deciliter (mean, 139). The primary end point was a fatal coronary event or a nonfatal myocardial infarction. Results: The frequency of the primary end point was 10.2 percent in the pravastatin group and 13.2 percent in the placebo group, an absolute difference of 3 percentage points and a 24 percent reduction in risk (95 percent confidence interval, 9 to 36 percent; P = 0.003). Coronary bypass surgery was needed in 7.5 percent of the patients in the pravastatin group and 10 percent of those in the placebo group, a 26 percent reduction (P = 0.005), and coronary angioplasty was needed in 8.3 percent of the pravastatin group and 10.5 percent of the placebo group, a 23 percent reduction (P = 0.01). The frequency of stroke was reduced by 31 percent (P = 0.03). There were no significant differences in overall mortality or mortality from noncardiovascular causes. Pravastatin lowered the rate of coronary events more among women than among men. The reduction in coronary events was also greater in patients with higher pretreatment levels of LDL cholesterol. Conclusions: These results demonstrate that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels.

Original languageEnglish (US)
Pages (from-to)1001-1009
Number of pages9
JournalNew England Journal of Medicine
Volume335
Issue number14
DOIs
StatePublished - Oct 3 1996

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Pravastatin
Myocardial Infarction
Cholesterol
Placebos
LDL Cholesterol
Coronary Disease
Mortality
Risk Reduction Behavior
Hypercholesterolemia
Angioplasty
Stroke
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

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The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. / Sacks, Frank M.; Pfeffer, Marc A.; Moye, Lemuel A.; Rouleau, Jean L.; Rutherford, John D.; Cole, Thomas G.; Brown, Lisa; Warnica, J. Wayne; Arnold, J. Malcolm O; Wun, Chuan Chuan; Davis, Barry R.; Braunwald, Eugene.

In: New England Journal of Medicine, Vol. 335, No. 14, 03.10.1996, p. 1001-1009.

Research output: Contribution to journalArticle

Sacks, FM, Pfeffer, MA, Moye, LA, Rouleau, JL, Rutherford, JD, Cole, TG, Brown, L, Warnica, JW, Arnold, JMO, Wun, CC, Davis, BR & Braunwald, E 1996, 'The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels', New England Journal of Medicine, vol. 335, no. 14, pp. 1001-1009. https://doi.org/10.1056/NEJM199610033351401
Sacks, Frank M. ; Pfeffer, Marc A. ; Moye, Lemuel A. ; Rouleau, Jean L. ; Rutherford, John D. ; Cole, Thomas G. ; Brown, Lisa ; Warnica, J. Wayne ; Arnold, J. Malcolm O ; Wun, Chuan Chuan ; Davis, Barry R. ; Braunwald, Eugene. / The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. In: New England Journal of Medicine. 1996 ; Vol. 335, No. 14. pp. 1001-1009.
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T1 - The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels

AU - Sacks, Frank M.

AU - Pfeffer, Marc A.

AU - Moye, Lemuel A.

AU - Rouleau, Jean L.

AU - Rutherford, John D.

AU - Cole, Thomas G.

AU - Brown, Lisa

AU - Warnica, J. Wayne

AU - Arnold, J. Malcolm O

AU - Wun, Chuan Chuan

AU - Davis, Barry R.

AU - Braunwald, Eugene

PY - 1996/10/3

Y1 - 1996/10/3

N2 - Background: In patients with high cholesterol levels, lowering the cholesterol level reduces the risk of coronary events, but the effect of lowering cholesterol levels in the majority of patients with coronary disease, who have average levels, is less clear. Methods: In a double-blind trial lasting five years, we administered either 40 mg of pravastatin per day or placebo to 4159 patients (3583 men and 576 women) with myocardial infarction who had plasma total cholesterol levels below 240 mg per deciliter (mean, 209) and low-density lipoprotein (LDL) cholesterol levels of 115 to 174 mg per deciliter (mean, 139). The primary end point was a fatal coronary event or a nonfatal myocardial infarction. Results: The frequency of the primary end point was 10.2 percent in the pravastatin group and 13.2 percent in the placebo group, an absolute difference of 3 percentage points and a 24 percent reduction in risk (95 percent confidence interval, 9 to 36 percent; P = 0.003). Coronary bypass surgery was needed in 7.5 percent of the patients in the pravastatin group and 10 percent of those in the placebo group, a 26 percent reduction (P = 0.005), and coronary angioplasty was needed in 8.3 percent of the pravastatin group and 10.5 percent of the placebo group, a 23 percent reduction (P = 0.01). The frequency of stroke was reduced by 31 percent (P = 0.03). There were no significant differences in overall mortality or mortality from noncardiovascular causes. Pravastatin lowered the rate of coronary events more among women than among men. The reduction in coronary events was also greater in patients with higher pretreatment levels of LDL cholesterol. Conclusions: These results demonstrate that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels.

AB - Background: In patients with high cholesterol levels, lowering the cholesterol level reduces the risk of coronary events, but the effect of lowering cholesterol levels in the majority of patients with coronary disease, who have average levels, is less clear. Methods: In a double-blind trial lasting five years, we administered either 40 mg of pravastatin per day or placebo to 4159 patients (3583 men and 576 women) with myocardial infarction who had plasma total cholesterol levels below 240 mg per deciliter (mean, 209) and low-density lipoprotein (LDL) cholesterol levels of 115 to 174 mg per deciliter (mean, 139). The primary end point was a fatal coronary event or a nonfatal myocardial infarction. Results: The frequency of the primary end point was 10.2 percent in the pravastatin group and 13.2 percent in the placebo group, an absolute difference of 3 percentage points and a 24 percent reduction in risk (95 percent confidence interval, 9 to 36 percent; P = 0.003). Coronary bypass surgery was needed in 7.5 percent of the patients in the pravastatin group and 10 percent of those in the placebo group, a 26 percent reduction (P = 0.005), and coronary angioplasty was needed in 8.3 percent of the pravastatin group and 10.5 percent of the placebo group, a 23 percent reduction (P = 0.01). The frequency of stroke was reduced by 31 percent (P = 0.03). There were no significant differences in overall mortality or mortality from noncardiovascular causes. Pravastatin lowered the rate of coronary events more among women than among men. The reduction in coronary events was also greater in patients with higher pretreatment levels of LDL cholesterol. Conclusions: These results demonstrate that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels.

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