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This study was designed to examine the hypothesis that pravastatin will reduce
myocardial infarction and stroke events in elderly patients with existing vascular
disease or at a high risk of developing the condition.
- a randomised controlled trial in which we assigned 5804 men (n=2804) and
women (n=3000) aged 70-82 years with a history of, or risk factors for, vascular
disease to pravastatin (40 mg per day; n=2891) or placebo (n=2913). Baseline
cholesterol concentrations ranged from 4.0 mmol/L to 9.0 mmol/L. Follow-up
was 3.2 years on average and our primary endpoint was a composite of coronary
death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Analysis
was by intention-to-treat
- pravastatin lowered LDL cholesterol concentrations by 34% and reduced the
incidence of the primary endpoint to 408 events compared with 473 on placebo
(hazard ratio 0.85, 95% CI 0.74-0.97, p=0.014). Coronary heart disease death
and non-fatal myocardial infarction risk was also reduced (0.81, 0.69-0.94,
p=0.006). Stroke risk was unaffected (1.03, 0.81-1.31, p=0.8), but the hazard
ratio for transient ischaemic attack was 0.75 (0.55-1.00, p=0.051). New cancer
diagnoses were more frequent on pravastatin than on placebo (1.25, 1.04-1.51,
p=0.020). However, incorporation of this finding in a meta-analysis of all
pravastatin and all statin trials showed no overall increase in risk. Mortality
from coronary disease fell by 24% (p=0.043) in the pravastatin group. Pravastatin
had no significant effect on cognitive function or disability
This study provides evidence that older people aged between 70 and 82 years
can reduce their risk of dying from coronary heart disease by almost a quarter
and of having a myocardial infarction by almost one fifth through treatment
with cholesterol lowering pravastatin for 3 years.
in elderly individuals at risk of vascular disease (PROSPER): a randomised
controlled trial. Lancet. 2002 Nov 23;360(9346):1623-30.
Last reviewed 10/2020