Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: Subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial

Ronald B Goldberg, Margot J. Mellies, Frank M. Sacks, Lemuel A. Moyé, Barbara V. Howard, William James Howard, Barry R. Davis, Thomas G. Cole, Marc A. Pfeffer, Eugene Braunwald

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Abstract

Background-Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. Methods and Results-The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes-136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides-were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P = 0.05)and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50%, P=0.05 for nonfatal MI). Conclusions- Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

Original languageEnglish
Pages (from-to)2513-2519
Number of pages7
JournalCirculation
Volume98
Issue number23
StatePublished - Dec 8 1998

Fingerprint

Pravastatin
Survivors
Myocardial Infarction
Cholesterol
Glucose
Fasting
Coronary Disease
Lipids
LDL Cholesterol
Placebos
Placebo Effect
HDL Cholesterol
Triglycerides
Therapeutics

Keywords

  • Coronary disease
  • Diabetes mellitus
  • Glucose
  • Lipoproteins

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels : Subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial. / Goldberg, Ronald B; Mellies, Margot J.; Sacks, Frank M.; Moyé, Lemuel A.; Howard, Barbara V.; Howard, William James; Davis, Barry R.; Cole, Thomas G.; Pfeffer, Marc A.; Braunwald, Eugene.

In: Circulation, Vol. 98, No. 23, 08.12.1998, p. 2513-2519.

Research output: Contribution to journalArticle

Goldberg, Ronald B ; Mellies, Margot J. ; Sacks, Frank M. ; Moyé, Lemuel A. ; Howard, Barbara V. ; Howard, William James ; Davis, Barry R. ; Cole, Thomas G. ; Pfeffer, Marc A. ; Braunwald, Eugene. / Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels : Subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial. In: Circulation. 1998 ; Vol. 98, No. 23. pp. 2513-2519.
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abstract = "Background-Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. Methods and Results-The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1{\%}) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes-136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides-were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27{\%} and 28{\%}) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37{\%} versus 25{\%}). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1{\%} and 5.2{\%} and the relative risk by 25{\%} (P = 0.05)and 23{\%} (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32{\%} (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13{\%} versus 10{\%} for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50{\%}, P=0.05 for nonfatal MI). Conclusions- Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.",
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T2 - Subgroup analyses in the Cholesterol And Recurrent Events (CARE) trial

AU - Goldberg, Ronald B

AU - Mellies, Margot J.

AU - Sacks, Frank M.

AU - Moyé, Lemuel A.

AU - Howard, Barbara V.

AU - Howard, William James

AU - Davis, Barry R.

AU - Cole, Thomas G.

AU - Pfeffer, Marc A.

AU - Braunwald, Eugene

PY - 1998/12/8

Y1 - 1998/12/8

N2 - Background-Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. Methods and Results-The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes-136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides-were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P = 0.05)and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50%, P=0.05 for nonfatal MI). Conclusions- Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

AB - Background-Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. Methods and Results-The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes-136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides-were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P = 0.05)and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50%, P=0.05 for nonfatal MI). Conclusions- Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

KW - Coronary disease

KW - Diabetes mellitus

KW - Glucose

KW - Lipoproteins

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