From the Department of Medicine, Brigham and Women's Hospital and
Harvard Medical School, Boston, Mass (F.M.S., M.A.P., E.B.); University of
Texas School of Public Health, Houston (L.A.M., B.R.D.); Washington
University, St Louis, Mo (T.G.C.); Montreal Heart Institute, Montreal, Quebec,
Canada (J.L.R.); and State University of New York Health Sciences Center,
Syracuse (D.T.N.).
Background—Although LDL lowering has
been shown to reduce recurrent coronary events in patients with
coronary heart disease, little direct information is available
on the extent of LDL lowering required to achieve this
outcome.
Methods and Results—The Cholesterol and Recurrent
Events (CARE) trial compared pravastatin and placebo in
patients who had experienced myocardial infarction (MI) who had average
concentrations of total cholesterol <240 mg/dL (baseline
mean, 209 mg/dL) and LDL cholesterol (LDL) 115 to 174 mg/dL
(mean, 139 mg/dL). Pravastatin reduced coronary
death or recurrent MI by 24%. In multivariate
analysis, the LDL concentration achieved during follow-up was a
significant, although nonlinear, predictor of the coronary
event rate (P=.007), whereas the extent of LDL reduction was
not significant, whether expressed as an absolute amount
(P=.97) or a percentage (P=.76). The
coronary event rate declined as LDL decreased during follow-up
from 174 to
Conclusions—The LDL concentrations achieved during treatment with
pravastatin or placebo were associated with reduction in
coronary events down to an LDL concentration of
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Relationship Between Plasma LDL Concentrations During Treatment With Pravastatin and Recurrent Coronary Events in the Cholesterol and Recurrent Events Trial
125 mg/dL, but no further decline was seen in the LDL
range from 125 to 71 mg/dL. In multivariate
analysis, triglyceride but not HDL concentrations
during follow-up were weakly but significantly associated with the
coronary event rate. 125 mg/dL.
LDL concentrations <125 mg/dL during treatment were not associated
with further benefit. Absolute or percentage reduction in LDL had
little relationship to coronary events.
Key Words: lipoproteins • cholesterol • coronary disease • drugs
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