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15 May 2001 | Volume 134 Issue 10 | Pages 931-940
Background: The effect of cholesterol-lowering therapy on death from coronary heart disease in older patients with previous coronary heart disease and average cholesterol levels is uncertain.
Objective: To compare the relative and absolute effects of pravastatin on cardiovascular disease outcomes in patients with coronary heart disease who are 65 years of age or older with those in patients 31 to 64 years of age.
Design: Subgroup analysis of a randomized, placebo-controlled trial.
Setting: 87 centers in Australia and New Zealand.
Patients: 3514 patients 65 to 75 years of age, chosen from among 9014 patients with previous myocardial infarction or unstable angina and a baseline plasma cholesterol level of 4.0 to 7.0 mmol/L (155 to 271 mg/dL).
Intervention: Pravastatin, 40 mg/d, or placebo.
Measurements: Major cardiovascular disease events over 6 years.
Results: Older patients were at greater risk than younger patients (31 to 64 years of age) for death (20.6% vs. 9.8%), myocardial infarction (11.4% vs. 9.5%), unstable angina (26.7% vs. 23.2%), and stroke (6.7% vs. 3.1%) (all P < 0.001). Pravastatin reduced the risk for all cardiovascular disease events, and similar relative effects were observed in older and younger patients. In patients 65 to 75 years of age, pravastatin therapy reduced mortality by 21% (CI, 7% to 32%), death from coronary heart disease by 24% (CI, 7% to 38%), coronary heart disease death or nonfatal myocardial infarction by 22% (CI, 9% to 34%), myocardial infarction by 26% (CI, 9% to 40%), and stroke by 12% (CI, –15% to 32%). For every 1000 older patients treated over 6 years, pravastatin prevented 45 deaths, 33 myocardial infarctions, 32 unstable angina events, 34 coronary revascularization procedures, 13 strokes, or 133 major cardiovascular events, compared with 22 deaths and 107 major cardiovascular events per 1000 younger patients. Among older patients, the numbers needed to treat were 22 (CI, 17 to 36) to prevent one death from any cause, 35 (CI, 24 to 67) to prevent one death from coronary heart disease, and 21 (CI, 17 to 31) to prevent one coronary heart disease death or nonfatal myocardial infarction.
Conclusions: In older patients with coronary heart disease and average or moderately elevated cholesterol levels, pravastatin therapy reduced the risk for all major cardiovascular events and all-cause mortality. Since older patients are at greater risk than younger patients for these events, the absolute benefit of treatment is significantly greater in older patients.
Author and Article Information
From the Royal Melbourne Hospital and National Heart Foundation, Melbourne, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Wollongong Hospital, Wollongong, and Fremantle Hospital, Perth, Australia; and Hutt Hospital, Lower Hutt, New Zealand.
Grant Support: The LIPID trial was supported by a grant from Bristol-Myers Squibb and was coordinated independently by the National Health and Medical Research Council Clinical Trials Centre under the auspices of the National Heart Foundation of Australia.
Acknowledgments: The authors thank the LIPID study investigators and coordinators at each of the participating centers (listed in reference 12); the patients from the participating centers, for their commitment to the study; and Rhana Pike, for assistance with the manuscript.
Requests for Single Reprints: John Simes, MD, National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown NSW 1450, Australia; e-mail, enquiry{at}ctc.usyd.edu.au.
Current Author Addresses: Dr. Hunt: Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Parkville Vic 3050, Australia.
Ms. Young, Dr. Simes, and Dr. Hague: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown NSW 1450, Australia.
Dr. Mann: Cardiology Department, Hutt Hospital, Private Bag 31907, Lower Hutt, New Zealand.
Dr. Owensby: Cardiology Department, Wollongong Hospital, Crown Street, Wollongong NSW 2500, Australia.
Dr. Lane: Department of Cardiovascular Medicine, Fremantle Hospital, PO Box 480, Fremantle WA 6160, Australia.
Dr. Tonkin: National Heart Foundation of Australia, 411 King Street, West Melbourne Vic 3003, Australia.
Author Contributions: Conception and design: D. Hunt, J. Simes, A. Tonkin.
Analysis and interpretation of the data: D. Hunt, P. Young, J. Simes, W. Hague, S. Mann, D. Owensby.
Drafting of the article: D. Hunt, P. Young, J. Simes, G. Lane. Critical revision for important intellectual contact: D. Hunt, J. Simes, W. Hague, S. Mann, D. Owensby, G. Lane, A. Tonkin.
Final approval of the article: D. Hunt, P. Young, J. Simes, W. Hague, S. Mann, D. Owensby, G. Lane, A. Tonkin.
Statistical expertise: P. Young, J. Simes.
Obtaining of funding: D. Hunt, J. Simes, A. Tonkin. Administrative, technical or logistic support: J. Simes.
Collection and assembly of data: J Simes. ARTICLE
Benefits of Pravastatin on Cardiovascular Events and Mortality in Older Patients with Coronary Heart Disease Are Equal to or Exceed Those Seen in Younger Patients: Results from the LIPID Trial
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