Prevention of mortality from coronary heart disease with pravastatin

Cardiovascular disease extracts a heavy burden on society. Until recently, the role of cholesterol lowering in coronary heart disease (CHD) patients has been debated, largely because there was no clear evidence that mortality could be reduced, particularly in patients with relatively normal cholesterol levels. Large-scale, placebo-controlled trials of pravastatin have now demonstrated however, a clear benefit and the safety of this HMG CoA reductase inhibitor. In typical patients with coronary heart disease and average cholesterol levels, pravastatin reduces cardiovascular events, coronary heart disease-related deaths and total mortality when compared to placebo (secondary prevention). Myocardial infarction and mortality from coronary heart disease is also reduced in patients with elevated cholesterol levels without preexisting coronary heart disease (primary prevention). The magnitude of this benefit depends on the particular cohort and absolute risk, which has implications for health strategy. Potential mechanisms of action of pravastatin in addition to lipid lowering are also discussed.