Homocysteine levels and treatment effect in the prospective study of pravastatin in the elderly at risk

Drewes, Y.M. et al. (2014) Homocysteine levels and treatment effect in the prospective study of pravastatin in the elderly at risk. Journal of the American Geriatrics Society, 62(2), pp. 213-221. (doi: 10.1111/jgs.12660)

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Objectives: To assess the effect of preventive pravastatin treatment on coronary heart disease (CHD) morbidity and mortality in older persons at risk for cardiovascular disease (CVD), stratified according to plasma levels of homocysteine.<p></p> Design: A post hoc subanalysis in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), started in 1997, which is a double-blind, randomized, placebo-controlled trial with a mean follow-up of 3.2 years.<p></p> Setting: Primary care setting in two of the three PROSPER study sites (Netherlands and Scotland).<p></p> Participants: Individuals (n = 3,522, aged 70–82, 1,765 male) with a history of or risk factors for CVD were ranked in three groups depending on baseline homocysteine level, sex, and study site.<p></p> Intervention: Pravastatin (40 mg) versus placebo.<p></p> Measurements: Fatal and nonfatal CHD and mortality.<p></p> Results: In the placebo group, participants with a high homocysteine level (n = 588) had a 1.8 higher risk (95% confidence interval (CI) = 1.2–2.5, P = .001) of fatal and nonfatal CHD than those with a low homocysteine level (n = 597). The absolute risk reduction in fatal and nonfatal CHD with pravastatin treatment was 1.6% (95% CI = −1.6 to 4.7%) in the low homocysteine group and 6.7% (95% CI = 2.7–10.7%) in the high homocysteine group (difference 5.2%, 95% CI = 0.11–10.3, P = .046). Therefore, the number needed to treat (NNT) with pravastatin for 3.2 years for benefit related to fatal and nonfatal CHD events was 14.8 (95% CI = 9.3–36.6) for high homocysteine and 64.5 (95% CI = 21.4–∞) for low homocysteine.<p></p> Conclusion: In older persons at risk of CVD, those with high homocysteine are at highest risk for fatal and nonfatal CHD. With pravastatin treatment, this group has the highest absolute risk reduction and the lowest NNT to prevent fatal and nonfatal CHD.<p></p>

Item Type:Articles
Glasgow Author(s) Enlighten ID:Stott J, Professor David and Ford, Professor Ian and Sattar, Professor Naveed
Authors: Drewes, Y.M., Poortvliet, R.K.E., Blom, J.W., de Ruijter, W., Westendorp, R.G.J., Stott, D.J., Blom, H.J., Ford, I., Sattar, N., Wouter Jukema, J., Assendelft, W.J.J., de Craen, A.J.M., and Gussekloo, J.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American Geriatrics Society
Publisher:Wiley-Blackwell Publishing Ltd.
ISSN (Online):1532-5415
Copyright Holders:Copyright © 2014 The Authors
First Published:First published in Journal of the American Geriatrics Society 62(2):213-221
Publisher Policy:Reproduced under a Creative Commons License

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