Evidence map›Statins × cardiovascular events›PMID 9841599›Full record

Trial reportAnnals of internal medicine1998

Effect of pravastatin on cardiovascular events in older patients with myocardial infarction and cholesterol levels in the average range. Results of the Cholesterol and Recurrent Events (CARE) trial.

S J Lewis, L A Moye, F M Sacks, D E Johnstone, G Timmis, J Mitchell, M Limacher, S Kell, S P Glasser, J Grant and 3 more

Abstract readClinical TrialRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Annals of internal medicine, 1998. The graph read 4 numbers from its abstract, feeding 1 cell of the map: it supports the treatment in 1. Cited by 77 papers, 8 of them syntheses that pooled it.

4numbers the graph read from it
1cell of the map it votes in
77citing papers in PubMed, 8 pooled it
24.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
-40.013.00 · no effect
Cardiovascular eventsfavours the treatment · against placebo · ascvd, dyslipidemiafeeds one cell of the map
reduction -32.0P < 0.001
RESULTS: Major coronary events occurred in 28.1% of placebo recipients and 19.7% of pravastatin recipients (difference, 9.0 percentage points [95% CI, 4 to 13 percentage points]; relative risk reduction, 32%; P < 0.001).
FeedsStatins×cardiovascular events
Cardiovascular eventsfavours the treatment · against placebo · ascvd, dyslipidemiafeeds one cell of the map
absolute reduction -2.90-4.50 to -0.30P = 0.03
Stroke incidence was 7.3% in the placebo group and 4.5% in the pravastatin group (absolute reduction, 2.9 percentage points [CI, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03).
FeedsStatins×cardiovascular events
Cardiovascular eventsfavours the comparator · against placebo · ascvd, dyslipidemiafeeds one cell of the map
Δ 9.004.00 to 13.0P < 0.001
RESULTS: Major coronary events occurred in 28.1% of placebo recipients and 19.7% of pravastatin recipients (difference, 9.0 percentage points [95% CI, 4 to 13 percentage points]; relative risk reduction, 32%; P < 0.001).
FeedsStatins×cardiovascular events
Cardiovascular eventsfavours the treatment · against placebo · ascvd, dyslipidemiafeeds one cell of the map
relative reduction -40.0P = 0.03
Stroke incidence was 7.3% in the placebo group and 4.5% in the pravastatin group (absolute reduction, 2.9 percentage points [CI, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03).
FeedsStatins×cardiovascular events

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

SupportsOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without it
0.85This paper moves it by +0.01.
← favours the treatmentfavours the comparator →
0 · no effect
This paper · 1998
reduction -32.0
Effect of Loading Dose of Atorvastatin Prior to Planned Percutaneous C…PMID 29525821 · 4,191 enrolled · 2012
Δ 0.85-0.70 to 2.41
NCT002899002,340 enrolled · 2006
Δ -0.10-0.40 to 0.60
NCT01294683977 enrolled · 2011
Δ 0.00-0.97 to 0.97
NCT00728988499 enrolled · 2008
Δ 1.00-7.30 to 9.30
Pravastatin and cardiovascular risk in moderate chronic kidney disease…PMID 19423108 · 2009
RR 55.0
Cardiovascular events and their reduction with pravastatin in diabetic…PMID 9843456 · 1998
reduced -32.0
Reduced coronary events in simvastatin-treated patients with coronary …PMID 10597756
RR 0.52
Prevention of cardiovascular events and death with pravastatin in pati…PMID 9841303 · 1998
reduction -29.0
Primary prevention of cardiovascular disease with atorvastatin in type…PMID 15325833
reduction -37.0-52.0 to -17.0
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

77 citing papers in PubMed, 8 syntheses or guidelines pooled it, 433 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. 2018 Guidelines for the management of dyslipidemia.The Korean journal of internal medicine · 2019
    Guideline
  5. Pooled it
  6. Pooled it
  7. Guideline
  8. Guideline
  9. Trial
  10. Trial
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. 2018 Guidelines for the Management of Dyslipidemia in Korea.Journal of lipid and atherosclerosis · 2019
    Review
  17. Review
  18. Diagnosis and Management of Statin Intolerance.Journal of atherosclerosis and thrombosis · 2019 · on this map
    Review
  19. Article
  20. Article

17 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

13 authors at 1 institution in 1 country.

S J LewisLegacy Portland Hospital, Portland Cardiovascular Institute, Oregon 97210, USA.
L A Moye
F M Sacks
D E Johnstone
G Timmis
J Mitchell
M Limacher
S Kell
S P Glasser
J Grant
B R Davis
M A Pfeffer
E Braunwald
Textron Systems (United Kingdom) · GB

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundA majority of all myocardial infarctions occur in patients who are 65 years of age or older and have average cholesterol levels, but little information is available on whether cholesterol lowering in such patients reduces the rate of recurrent cardiovascular disease.

objectiveTo determine whether pravastatin reduces the rate of recurrent cardiovascular events in older patients.

designSubset analysis of a randomized, controlled trial.

setting80 hospitals and affiliates in the United States and Canada. PATIENTS: 1283 patients aged 65 to 75 years who had had myocardial infarction and had a plasma total cholesterol level less than 6.2 mmol/L (240 mg/dL) and a low-density lipoprotein cholesterol level of 3.0 to 4.5 mmol/L (115 to 174 mg/dL).

interventionPravastatin, 40 mg/d, or placebo. MEASUREMENTS: Five-year event rates of major coronary events (coronary death, nonfatal myocardial infarction, angioplasty, or bypass surgery) and stroke.

resultsMajor coronary events occurred in 28.1% of placebo recipients and 19.7% of pravastatin recipients (difference, 9.0 percentage points [95% CI, 4 to 13 percentage points]; relative risk reduction, 32%; P < 0.001). Coronary death occurred in 10.3% of the placebo group and in 5.8% of the pravastatin group (difference, 4.6 percentage points [CI, 1.9 to 6.5 percentage points]; relative risk reduction, 45%; P = 0.004). Stroke incidence was 7.3% in the placebo group and 4.5% in the pravastatin group (absolute reduction, 2.9 percentage points [CI, 0.3 to 4.5 percentage points]; relative reduction, 40%; P = 0.03). The numbers of older patients needed to treat for 5 years were 11 (CI, 8 to 24) to prevent a major coronary event and 22 (CI, 15 to 53) to prevent a coronary death. For every 1000 older patients treated, 225 cardiovascular hospitalizations would be prevented compared with 121 hospitalizations in 1000 younger patients.

conclusionsIn older patients with myocardial infarction and cholesterol levels in the average range, pravastatin is associated with a clinically important reduction in risk for major coronary events and stroke. Given the high cardiovascular event rate in older patients, the potential for absolute benefit in this age group is substantial.

Indexed as

AgedAnticholesteremic AgentsCardiovascular DiseasesCholesterolCholesterol, LDLDouble-Blind MethodFemaleHumansMaleMyocardial InfarctionPravastatinRecurrenceStatistics as TopicAnticholesteremic AgentsCholesterolCholesterol, LDLPravastatin

Identifiers

PMID9841599
OpenAlexW2135171522

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.