The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels

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

doi:10.1056/nejm199610033351401

Cited by 6,778 publications

(3,472 citation statements)

References 30 publications

(36 reference statements)

Supporting

Mentioning

3,253

Contrasting

Unclassified

139

Order By: Relevance

“…Adults with clinical CHD have a ≥26% 10‐year risk of another CHD event. Patients with CHD risk equivalent status, excluding diabetes mellitus,6 have a 10‐year CHD risk of >20% 20, 30, 31. Respective risks of 26% and 21% were multiplied by 1.5, which assumes ASCVD 10 event rates were 50% greater than 10‐year CHD risk alone.…”

Section: Methodsmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Egan

White

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundHealthy People 2020 aim to reduce fatal atherosclerotic cardiovascular disease (ASCVD) by 20%, which translates into 310 000 fewer events annually assuming proportional reduction in fatal and nonfatal ASCVD. We estimated preventable ASCVD events by implementing the American College of Cardiology/American Heart Association (ACC/AHA) 2013 Cholesterol Guideline in all statin‐eligible adults. Absolute risk reduction (ARR) and number needed‐to‐treat (NNT) were calculated.Methods and ResultsNational Health and Nutrition Examination Survey data for 2007–2012 were analyzed for adults aged 21 to 79 years and extrapolated to the US population. Literature‐guided assumptions were used including (1) low‐density lipoprotein cholesterol falls 33% with moderate‐intensity statins and 51% with high‐intensity statins; (2) for each 39 mg/dL decline in low‐density lipoprotein cholesterol, 10‐year ASCVD 10 risk would fall 21% when ASCVD 10 risk was ≥20% and 33% when ASCVD 10 risk was <20%; and (3) either all statin‐eligible untreated adults or all with ASCVD 10 risk ≥7.5% would receive statins. Of 175.9 million adults aged 21 to 79 years not taking statins, 44.8 million (25.5%) were statin eligible. Treating all statin‐eligible adults would prevent an estimated 243 589 ASCVD events annually (ARR 5.4%, 10‐year NNT 18). Treating all statin‐eligible adults with ASCVD 10 risk ≥7.5% reduces the number treated to 32.2 million (28.2% fewer), whereas ASCVD events prevented annually fall only 10.5% to 217 974 (6.8% ARR, NNT 15).ConclusionsImplementing the ACC/AHA 2013 Cholesterol Guideline in all untreated, statin‐eligible adults could achieve ≈78% of the Healthy People 2020 ASCVD prevention goal. Most of the benefit is attained by individuals with 10‐year ASCVD risk ≥7.5%.

show abstract

Section: Methodsmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Egan

White

et al. 2016

JAHA

View full text Add to dashboard Cite

show abstract

“…the excess of diabetes cases with statin therapy first noticed in the JUPITER trial 47 was found to be smaller in the other statin trials 48 ) or may not even be real (e.g. the small excesses of incident cancer cases in the CARE and PROSPER trials 49,50 were not confirmed by the much larger numbers of cases in the other statin trials 51,52 ).…”

Section: Value Of Meta-analyses Of Randomized Trialsmentioning

confidence: 95%

“…31,51 In a large database analysis, a few years of statin therapy was associated with a 15% proportionally lower rate of cancer-related mortality after adjustment for the potential confounding factors that had been recorded 90 and, in some other observational studies, 136 with as much as a halving in colon cancer incidence and in prostate cancer mortality. 137,138 By contrast, there were small excesses of incident breast cancer in the CARE trial 49 and of incident cancer at all sites in the PROSPER trial among patients who were randomized to receive statin therapy. 50 However, based on more than 10,000 cases of incident cancer in the CTT meta-analyses (including CARE and PROSPER), there were no apparent effects -either overall or at any particular site -during an average of 5 years of statin therapy ( Figure 7).…”

Section: Lack Of Effects On Non-vascular Mortality and Cancermentioning

confidence: 96%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

View full text Add to dashboard Cite

General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

show abstract

“…However, most studies that have supported a “lower is better” linear relationship between LDL cholesterol and outcomes have been conducted in younger populations. Indeed, elderly populations have been significantly under‐represented in statin and PCSK‐9 inhibitor outcome trials 5, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Our study suggests that the linear “dose‐dependent” relationship between LDL cholesterol and outcomes may not apply to elderly populations on statins following ACS hospitalizations, and the effectiveness of using aggressive LDL cholesterol targets among such elderly subpopulations may be unwarranted.…”

Section: Discussionmentioning

confidence: 91%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

show abstract

The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels

Abstract: These results demonstrate that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels.

Cited by 6,778 publications

References 30 publications

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

2013 ACC/AHA Cholesterol Guideline and Implications for Healthy People 2020 Cardiovascular Disease Prevention Goals

Interpretation of the evidence for the efficacy and safety of statin therapy

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Contact Info

Product

Resources

About