(Circulation. 1996;94:1503-1505.)
© 1996 American Heart Association, Inc.
Articles |
Reduction of Transient Myocardial Ischemia With Pravastatin in Addition to the Conventional Treatment in Patients With Angina Pectoris
the Department of Cardiology, Thoraxcenter, University Hospital Groningen (A.J.v.B., H.J.G.M.C., K.I.L.); the Department of Medical Statistics, State University, Leiden (A.H.Z.); the Interuniversity Cardiology Institute, Utrecht (A.J.v.B., J.W.J., A.H.Z., H.J.G.M.C., K.I.L., A.V.G.B.); and the Department of Cardiology, University Hospital Leiden (J.W.J., A.V.G.B.), the Netherlands.
Correspondence to Ad J. van Boven, MD, Thoraxcenter, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, Netherlands.
Background Lipid-lowering therapy reduces cardiac morbidity and mortality. Less is known about its potential anti-ischemic effect.
Methods and Results In a 2-year prospective randomized placebo-controlled study, the effect of pravastatin 40 mg on transient myocardial ischemia was assessed. Forty-eight–hour ambulatory ECGs with continuous ST-segment analysis were performed in 768 male patients with stable angina pectoris, documented coronary artery disease, and serum cholesterol between 4 and 8 mmol/L (155 and 310 mg/dL). During the trial, patients received routine antianginal treatment. In the patients randomized to pravastatin, transient myocardial ischemia was present at baseline in 28% and after treatment in 19%; in the placebo group, it was found in 20% and 23% of the patients, respectively (P=.021 for change in percentage between two treatment groups; odds ratio, 0.62; 95% CI, 0.41 to 0.93). Ischemic episodes decreased by 1.23±0.25 (SEM) episode with pravastatin and by 0.53±0.25 episode with placebo (P=.047). Under pravastatin, the duration of ischemia decreased from 80±12 minutes to 42±10 minutes (P=.017) and with placebo, from 60±13 minutes to 51±9 minutes (P=.56). The total ischemic burden decreased from 41±5 to 22±5 mm·min in the pravastatin group (P=.0058) and from 34±6 to 26±4 mm·min in the placebo group (P=.24). Adjusted for independent risk factors for the occurrence of ischemia, the effect of pravastatin on the reduction of risk for ischemia remained statistically significant (odds ratio, 0.45; 95% CI, 0.22 to 0.91; P=.026).
Conclusions In men with documented coronary artery disease and optimal antianginal therapy, pravastatin reduces transient myocardial ischemia. (Circulation. 1996;94:1503-1505.)
Key Words: drugs • cholesterol • electrocardiography • ischemia
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