| 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). | |
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MedLine Citation:
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PMID: 19958861 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: American heart journal Volume: 158 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-12-04 Completed Date: 2010-01-06 Revised Date: 2011-03-03 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 948-55 Citation Subset: AIM; IM |
Affiliation:
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HealthPartners Research Foundation, Minneapolis, MN 55440-1524, USA. karen.l.margolis@healthpartners.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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N01 HC035130/HC/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Antihypertensive Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Hypolipidemic Agents; 81093-37-0/Pravastatin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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