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• W2040271175 abstract "Several large-scale statin trials have shown that cholesterol-lowering therapy produces substantial benefits for high-risk individuals, 1 Scandinavian Simvastatin Survival Study GroupRandomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian simvastatin survival study (4S). Lancet. 1994; 344: 1383-1389 Summary PubMed Scopus (11353) Google Scholar , 2 Shepherd J Cobbe SM Ford I et al. for the West of Scotland Coronary Prevention Study GroupPrevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med. 1995; 333: 1301-1307 Crossref PubMed Scopus (7514) Google Scholar , 3 Sacks FM Pfeffer MA Moye LA et al. for the Cholesterol and Recurrent Events Trial InvestigatorsThe effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996; 335: 1001-1009 Crossref PubMed Scopus (7239) Google Scholar , 4 The Post Coronary Artery Bypass Graft Trial InvestigatorsThe effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med. 1997; 336: 153-162 Crossref PubMed Scopus (977) Google Scholar , 5 The Long-term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study GroupPrevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998; 339: 1349-1357 Crossref PubMed Scopus (5605) Google Scholar , 6 Downs JR Clearfield M Weis S et al. for the AFCAPS/TexCAPS Research GroupPrimary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA. 1998; 279: 1615-1622 Crossref PubMed Scopus (5030) Google Scholar , 7 Serruys PWJC de Feyter P Macaya C et al. for the Lescol Intervention Prevention Study (LIPS) InvestigatorsFluvastatin for prevention of cardiac events following successful first percutaneous coronary intervention: a randomised controlled trial. JAMA. 2002; 287: 3215-3222 Crossref PubMed Scopus (703) Google Scholar , 8 Heart Protection Study Collaborative GroupMRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360: 7-22 Summary Full Text Full Text PDF PubMed Scopus (7711) Google Scholar not just in middle age but also in old age, 8 Heart Protection Study Collaborative GroupMRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360: 7-22 Summary Full Text Full Text PDF PubMed Scopus (7711) Google Scholar , 9 Hunt D Young P Simes J et al. for the LIPID investigatorsBenefits of pravastatin on cardiovascular events and mortality in older patients with coronary heart disease are equal to or exceed those seen in younger patients: results from the LIPID trial. Ann Intern Med. 2001; 134: 931-940 Crossref PubMed Scopus (233) Google Scholar and the PROSPER trial reported in today's Lancet reinforces those findings for the elderly. Typically, in the previous trials, a 1 mmol/L reduction in plasma LDL cholesterol concentration maintained for about 5 years reduced the risks of coronary events, of strokes, and of revascularisation procedures by about one quarter (although the proportional reduction in risk appeared to be somewhat smaller during the first year after starting treatment). In PROSPER, 5804 high-risk individuals aged 70–82 (mean 75) years with mean LDL cholesterol of 3·8 mmol/L at entry were randomly allocated to receive 40 mg pravastatin daily or placebo for an average of 3·2 years. Despite a lowering of LDL cholesterol by an average of about 1·0 mmol/L during the study, however, allocation to pravastatin was associated with a proportional reduction of “only” 15% (SE 7, 95% CI 3–26) in the primary outcome of coronary death, non-fatal myocardial infarction, or stroke (408 [14·1%] pravastatin vs 473 [16·2%] placebo affected individuals, p=0·014). At least in part, this smaller than anticipated risk reduction may be due to chance, since the confidence interval around the estimate is wide and remains consistent with a reduction of one quarter. But it may also reflect the greater diluting effect on the overall risk reduction of a smaller reduction in risk during the first year after lowering LDL cholesterol in a trial involving 3 years of treatment (ie, 1 of 3 years) than in the previous statin trials that typically involved 5 years of treatment (ie, 1 of 5 years). Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trialPravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore extends to elderly individuals the treatment strategy currently used in middle aged people. Published online Nov 19, 2002 http://image.thelancet.com/extras/02art8325web.pdf Full-Text PDF" @default.
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• W2040271175 date "2002-11-01" @default.
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• W2040271175 title "High-risk elderly patients PROSPER from cholesterol-lowering therapy" @default.
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