Myocardial infarction, unstable angina: pravastatin reduced death, myocardial infarction and revascularisation

Clinical bottom line (level 1b)

  1. Patients with a recent myocardial infarction or episode of unstable angina and a cholesterol level 4.0 mmol/l or more who took pravastatin compared with placebo were less likely to die (NNT = 33 at 6 years) , have a myocardial infarction (NNT = 35 at 6 years) , require revascularisation (NNT = 36 at 6 years) or be hospitalised with unstable angina (NNT = 44 at 6 years) .
The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group : New England Journal of Medicine 1998; 339: 1349-1357
Expires March 2003

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: 87 acute hospitals, Australia and New Zealand

9014 patients (aged 31 to 75; median 62, 83% male) with myocardial infarction or hospital discharge of unstable angina within previous 3 to 36 months, and a cholesterol level 4.0 mmol/l to 7.0 mmol/l, and a fasting triglyceride level < 5.0 mmol/l.

Excluded if
  • clinically significant medical or surgical event within previous 3 months
  • cardiac failure, renal or hepatic disease
  • current use of cholesterol lowering drugs


    • Note:
  • Patients were stratified for MI or unstable angina and study centre before randomisation.
  • All patients had dietary advice 8 weeks before enrollment.


    • Control Group: (n = 4502, 4502 analysed): placebo
    Experimental Group: (n = 4512, 4512 analysed): pravastatin 40 mg once daily

    99.9% followed for 6 years

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    death 6 years 633
    (14.1%)    		 498
    (11.0%)    		 22%
    (12% to 30%)    		 3.02%
    (1.66% to 4.39%)    		 33
    (23 to 60)
    death from coronary heart disease 6 years 373
    (8.29%)    		 287
    (6.36%)    		 23%
    (11% to 34%)    		 1.92%
    (0.85% to 3.00%)    		 52
    (33 to 120)
    myocardial infarction 6 years 463
    (10.3%)    		 336
    (7.45%)    		 28%
    (17% to 37%)    		 2.84%
    (1.67% to 4.01%)    		 35
    (25 to 60)
    CABG or PTCA weeks 708
    (15.7%)    		 585
    (13.0%)    		 18%
    (9% to 26%)    		 2.76%
    (1.31% to 4.21%)    		 36
    (24 to 76)
    hospitalisation with unstable angina 6 weeks 1106
    (24.6%)    		 1005
    (22.3%)    		 9%
    (2% to 16%)    		 2.29%
    (0.54% to 4.04%)    		 44
    (25 to 180)

    Comments

    1. The dose used in this study was 40 mg daily and these data do not indicate whethera lower dose of pravastatin would be equally effective.
    2. The observation that the cross-over from the allocated treatment was 20% makes it possible that the effects of treatment were underestimated in this study.

    Citation

    1. The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group , : prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. New England Journal of Medicine 1998; 339: 1349-1357
    Search Terms: ?
    Contributor: Chris Ball and Bob Phillips, February 2000
    Reviewer: Robert McKelvie

    Clinical Question.
    Patient myocardial infarction or unstable angina
    Intervention or Exposure pravastatin
    Comparison placebo
    Outcome death, revascularisation, hospitalisation with unstable angina, myocardial infarction