Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range - Results of the cholesterol and recurrent events (CARE) trial
Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range - Results of the cholesterol and recurrent events (CARE) trial
复制标题
DOI：
10.7326/0003-4819-129-9-199811010-00002
复制
发表时间：
1998-11-01
影响因子：
39.2
通讯作者：
Braunwald, E
中科院分区：
文献类型：
--
作者：
Lewis, SJ;Moye, LA;Braunwald, E
背景资料：大多数心肌梗死患者年龄在65岁或以上，胆固醇水平处于平均水平，但关于此类患者降低胆固醇是否可降低心血管疾病复发率的信息很少。目的：确定普伐他汀是否可降低老年患者心血管事件复发率。设计：随机对照试验的子集分析。美国和加拿大的80家医院和附属机构。患者：1283名年龄在65至75岁之间的心肌梗死患者，血浆总胆固醇水平低于6.2 mmol/L（240 mg/dL）和低密度脂蛋白胆固醇水平为3.0至4.5 mmol/L干预：普伐他汀，40 mg/d，或安慰剂。测量：主要冠状动脉事件的5年事件率（冠状动脉死亡、非致命性心肌梗死、血管成形术或搭桥手术）和中风。安慰剂组和普伐他汀组的主要冠状动脉事件发生率分别为28.1%和19.7%（差异为9.0个百分点[95%CI，4 ~ 13个百分点];相对风险降低32%; P < 0.001）。安慰剂组和普伐他汀组的冠心病死亡率分别为10.3%和5.8%（差异为4.6个百分点[CI为1.9 ~ 6.5个百分点];相对风险降低45%; P = 0.004）。安慰剂组和普伐他汀组的卒中发生率分别为7.3%和4.5%（绝对降低，2.9个百分点[CI，0.3 - 4.5个百分点];相对降低，40%; P = 0.03）。需要治疗5年的老年患者人数为11人（CI，8至24），以防止重大冠状动脉事件和22（CI，15至53），以防止冠状动脉死亡。对于每1000名老年患者治疗，225心血管住院将被阻止相比，在1000年轻patients.Conclusions：在心肌梗死和胆固醇水平在平均范围内的老年患者中，普伐他汀与临床上重要的降低主要冠状动脉事件和中风的风险。鉴于老年患者的心血管事件发生率较高，该年龄组绝对获益的可能性很大。
Background: A majority of all myocardial infarctions occur in patients who are 65 years of age or older and have average cholesterol levels, but little information is available on whether cholesterol lowering in such patients reduces the rate of recurrent cardiovascular disease.Objective: To determine whether pravastatin reduces the rate of recurrent cardiovascular events in older patients.Design: Subset analysis of a randomized, controlled trial.Setting: 80 hospitals and affiliates in the United States and Canada.Patients: 1283 patients aged 65 to 75 years who had had myocardial infarction and had a plasma total cholesterol level less than 6.2 mmol/L (240 mg/dL) and a low-density lipoprotein cholesterol level of 3.0 to 4.5 mmol/L (115 to 174 mg/dL).Intervention: Pravastatin, 40 mg/d, or placebo.Measurements: Five-year event rates of major coronary events (coronary death, nonfatal myocardial infarction, angioplasty, or bypass surgery) and stroke.Results: Major coronary events occurred in 28.1% of placebo recipients and 19.7% of pravastatin recipients (difference, 9.0 percentage points [95% CI, 4 to 13 percentage points]; relative risk reduction, 32%; P < 0.001). Coronary death occurred in 10.3% of the placebo group and in 5.8% of the pravastatin group (difference, 4.6 percentage points [CI, 1.9 to 6.5 percentage points]; relative risk reduction, 45%; P = 0.004). Stroke incidence was 7.3% in the placebo group and 4.5% in the pravastatin group (absolute reduction, 2.9 percentage points [CI, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03). The numbers of older patients needed to treat for 5 years were 11 (CI, 8 to 24) to prevent a major coronary event and 22 (CI, 15 to 53) to prevent a coronary death. For every 1000 older patients treated, 225 cardiovascular hospitalizations would be prevented compared with 121 hospitalizations in 1000 younger patients.Conclusions: In older patients with myocardial infarction and cholesterol levels in the average range, pravastatin is associated with a clinically important reduction in risk for major coronary events and stroke. Given the high cardiovascular event rate in older patients, the potential for absolute benefit in this age group is substantial.