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PRIMARY PREVENTION OF CORONARY DISEASE WITH PRAVASTATIN.

Several trials of cholesterol-lowering drugs in patients without known coronary disease have shown reductions in coronary events but trends toward increased noncoronary death. This randomized study compared pravastatin (40 mg/day) with placebo in 6595 hypercholesterolemic Scottish men, age 45 to 64, with no history of myocardial infarction. Nearly 80 percent of the men were current or ex-smokers, and 5 percent had angina. At baseline, the mean total, LDL, and HDL cholesterol levels were 272, 192, and 44 mg/dl, respectively. Pravastatin reduced LDL cholesterol by 26 percent (versus no change in the placebo group). During a mean follow-up of five years, the rate of nonfatal MI or death from coronary disease was 5.5 percent in the pravastatin group and 7.9 percent in the placebo group, a significant difference. The pravastatin group also had lower mortality from coronary disease (1.2 vs. 1.7 percent) and lower total mortality (3.2 vs. 4.1 percent), but these differences just failed to achieve statistical significance. No important adverse effects were reported. Comment: This trial yields the most compelling results to date supporting primary preventive drug therapy for hypercholesterolemia. It also confirms the safety of a "statin" drug during five years of use.

— AS Brett

Published in Journal Watch General Medicine November 28, 1995

Citation(s):

Shepherd J, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995 Nov 16 333 1301-1307.

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