(Circulation. 2001;103:387.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Reduction of Stroke Events With Pravastatin
The Prospective Pravastatin Pooling (PPP) Project
From the Wake Forest University School of Medicine (R.P.B.), Winston-Salem, NC; University of Texas School of Public Health (B.R.D.), Houston; St Francis Hospital (J.F.P.), Roslyn, NY; Green Lane Hospital (H.D.W.), Auckland, New Zealand; Therapeutic Goods Administration (J.B.), Canberra, Australia; and University of Glasgow (S.M.C., J.S.), Glasgow, Scotland.
Correspondence to Robert P. Byington, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063. E-mail bbyingto{at}wfubmc.edu
Background—Stroke is a leading cause of death and disability. Although clinical trials of the early lipid-lowering therapies did not demonstrate a reduction in the rates of stroke, data from recently completed statin trials strongly suggest benefit.
Methods and Results—The
effect of pravastatin 40 mg/d on stroke events was investigated in a
prospectively defined pooled analysis of 3 large, placebo-controlled,
randomized trials that included 19 768 patients with 102 559
person-years of follow-up. In all, 598 participants had a stroke during
5 years of follow-up. The 2 secondary prevention trials (CARE
[Cholesterol And Recurrent Events] and LIPID [Long-term Intervention
with Pravastatin in Ischemic Disease]) individually demonstrated
reductions in nonfatal and total stroke rates. When the 13 173
patients from CARE and LIPID were combined, there was a 22% reduction
in total strokes (95% CI 7% to 35%,
P=0.01) and a 25% reduction in
nonfatal stroke (95% CI 10% to 38%). The beneficial effect of
pravastatin on total stroke was observed across a wide range of patient
characteristics. WOSCOPS (West of Scotland Coronary Prevention Study, a
primary prevention trial in hypercholesterolemic men) exhibited a
similar, although smaller, trend for a reduction in total stroke. Among
the CARE/LIPID participants, pravastatin was associated with a 23%
reduction in nonhemorrhagic strokes (95% CI 6% to 37%), but there
was no statistical treatment group difference in hemorrhagic or unknown
type.
Conclusions—Pravastatin reduced the risk of stroke over a wide range of lipid values among patients with documented coronary disease. This effect was due to a reduction in nonfatal nonhemorrhagic strokes.
Key Words: lipids • prevention • stroke • trials
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