[Pravastatin and acetylsalycilic acid fixed-combination: a strategy to improve cardiovascular outcomes]

The rationale behind combined statin-acetylsalicylic acid therapy is based on the beneficial effects ofacetylsalicylic acid on thrombosis, the leading immediate cause of the majority of occlusive cardiovascular events, and those of statins on atherosclerosis, which is the main underlying cause. The clinical benefits of combined pravastatin-acetylsalicylic acid in the management of coronary patients have been demonstrated by a meta-analysis of five randomized clinical trials for secondary prevention; compared with pravastatin alone, the pravastatin-acetylsalicylic acid combination reduced the risk of fatal or non fatal myocardial infarction by 26%, the risk of ischemic stroke by 31%, and the risk of cardiovascular events at 5 years by 13%. Combined pravastatin-acetylsalicylic acid therefore appears to significantly reduce the cardiovascular risk in coronary patients. Following the AHA/ACC and National Cholesterol Education Program (NCEP) I and II guidelines, the proportion of patients treated by acetylsalicylic acid, beta-blockers and statins increased significantly: 94%, 57% and 91% respectively at one year versus 68%, 18% and 10% before the guidelines were applied. The impact of these treatments on clinical outcomes is statistically significant in terms of recurrent myocardial infarction, the need for re-hospitalization, sudden death or all-cause mortality. Patients treated with combined statin-acetylsalicylic acid therapy have significantly improved clinical outcome and a significantly lower rate of coronary events at 1 year of follow-up. These data therefore confirm the importance of optimizing therapeutic management of coronary patients, and in particular with combined acetylsalicylic acid-statin therapy.