A prospective study of pravastatin in the elderly at risk: new hope for older persons

The role of cholesterol in coronary heart disease (CHD) and stroke in elderly persons is controversial. Statin studies have generally included mostly middle-aged men, been targeted at either primary or secondary prevention, and lasted 5-6 years. In contrast, the PROspective Study of Pravastatin in the Elderly at Risk was a double-blind, randomized, placebo-controlled primary and secondary prevention trial that examined the effects of pravastatin 40 mg/d on the risk of CHD, cerebral vascular events, and cognitive function over 3 years in 5804 high-risk elderly persons (mean age 75 years; 52% women). Pravastatin therapy significantly improved lipid levels: low-density lipoprotein cholesterol (-34%), high-density lipoprotein cholesterol (+5%), and triglycerides (-13%) and produced no adverse effects on liver function tests or myopathy. Moreover, pravastatin reduced the primary end point (CHD death, nonfatal myocardial infarction, and stroke) by 15% (p=0.014), including 24% reduction in CHD death (p=0.043) and 19% reduction in combined CHD death and nonfatal myocardial infarction (p=0.006). Although transient ischemic attacks fell by 25% (p=0.05) with pravastatin, there were no significant reductions in stroke or improvements in cognitive function. These results demonstrate the benefits of pravastatin in primary and, particularly, secondary prevention in elderly populations and further support the benefits of statin therapy in high-risk elderly persons.