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[Cholesterol lowering therapy after myocardial infarction. Consequences of the CARE study]
J E Otterstad1, E Hexeberg, I Holme
1Hjerteseksjonen, Vestfold Sentralsykehus, Tønsberg.
Insights
Pravastatin significantly reduced the risk of coronary events by 24% in patients with recent myocardial infarction. This cholesterol-lowering statin therapy is beneficial for a broad patient population.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cardiovascular disease remains a leading cause of mortality worldwide.
- Statins are a class of drugs used to lower cholesterol levels.
- Secondary prevention after myocardial infarction (MI) is crucial.
Purpose of the Study:
- To evaluate the efficacy of pravastatin in reducing cardiovascular events post-MI.
- To assess the impact of pravastatin on cholesterol levels in patients with specific lipid profiles.
Main Methods:
- The CARE study randomized 4,159 patients aged 21-75 years post-MI.
- Patients received pravastatin 40 mg daily or placebo for 3-20 months.
- Mean follow-up was five years, with specific inclusion criteria for cholesterol levels.
Main Results:
- Pravastatin treatment led to a 20% reduction in total cholesterol and 28% in LDL-cholesterol.
- A significant 24% reduction in coronary death or non-fatal MI was observed (p = 0.003).
- Cholesterol levels in CARE were comparable to Western populations, differing from the 4S study.
Conclusions:
- Pravastatin is effective in secondary prevention of cardiovascular events after myocardial infarction.
- The findings support statin therapy for patients with cholesterol levels similar to those in the CARE study population.
Abstract:
In the recently published CARE-study, 4,159 patients aged 21-75 years were included and randomised to treatment with pravastatin 40 mg once daily or placebo 3-20 months following a myocardial infarction. Inclusion criteria were a total cholesterol < 6.2 mmol/l and LDL-cholesterol 3.0-4.5 mmol/l. Mean follow-up time was five years. Average reduction of total cholesterol was 20% and of LDL-cholesterol 28% in the treatment group. The incidence of coronary death or non-fatal myocardial infarction was reduced by 24% (p = 0.003). The cholesterol levels in the CARE-study were similar to those in most western populations and lower than in the 4S study. This must be considered when evaluating the different results of the treatment in the two studies. It seems fair not only to offer statin treatment to patients complying with the 4S inclusion criteria, but also to patients with values as in the CARE population.