Document Detail


Coronary heart disease in moderately hypercholesterolemic, hypertensive black and non-black patients randomized to pravastatin versus usual care: the antihypertensive and lipid lowering to prevent heart attack trial (ALLHAT-LLT).
MedLine Citation:
PMID:  19958861     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In previous analyses in ALLHAT, blacks had a significantly lower risk of coronary heart disease (CHD) in the pravastatin group compared to the usual care group, whereas non-blacks had no benefit from pravastatin. No previous statin trial has reported results separately in blacks.
OBJECTIVES: The study aimed to determine if apparent racial differences in CHD in ALLHAT are explained by differences in baseline characteristics, adherence during the trial, or achieved blood pressure and lipid lowering.
METHODS: This was a prespecified subgroup analysis of a randomized controlled trial. Hypertensive, moderately hypercholesterolemic participants were assigned to open-label pravastatin (40 mg/d) or usual care. The outcome was a composite of nonfatal myocardial infarction and fatal CHD. We performed intention-to-treat survival analyses using Cox proportional hazards models, adjusting for baseline covariates (age, sex, aspirin use, history of CHD and diabetes, and baseline hypertension treatment) and time-varying levels of blood pressure and total cholesterol.
RESULTS: After adjustment for baseline characteristics, there remained a significant interaction between race and treatment group (P = .02). In stratified models, blacks in the pravastatin group had a 29% lower risk of CHD (hazard ratio [HR] 0.71, 95% CI 0.57-0.90, P = .005) compared to those in the usual care group, whereas non-blacks had no benefit (HR 1.00, 95% CI 0.85-1.19, P = .95). With further adjustment for achieved blood pressure and total cholesterol, the HR in blacks was 0.65 (95% CI 0.45-0.96, P = .03) and in non-blacks was 1.07 (95% CI 0.81-1.41, P = .65).
CONCLUSIONS: Our results suggest that pravastatin is effective in preventing CHD in blacks.
Authors:
Karen L Margolis; Kay Dunn; Lara M Simpson; Charles E Ford; Jeff D Williamson; David J Gordon; Paula T Einhorn; Jeffrey L Probstfield;
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  158     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-04     Completed Date:  2010-01-06     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  948-55     Citation Subset:  AIM; IM    
Affiliation:
HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA. karen.l.margolis@healthpartners.com
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MeSH Terms
Descriptor/Qualifier:
African Americans*
Aged
Antihypertensive Agents / therapeutic use
Coronary Disease / complications*,  prevention & control*
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Hypercholesterolemia / complications*,  drug therapy
Hypertension / complications*,  drug therapy
Hypolipidemic Agents / therapeutic use
Male
Middle Aged
Pravastatin / therapeutic use*
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
N01 HC035130/HC/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Hypolipidemic Agents; 81093-37-0/Pravastatin
Comments/Corrections

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