Ic. Marschner et al., Long-term risk stratification for survivors of acute coronary syndromes - Results from the long-term intervention with pravastatin in ischemic disease (LIPID) study, J AM COL C, 38(1), 2001, pp. 56-63
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
OBJECTIVES We developed a prognostic strategy for quantifying the long-term
risk of coronary heart disease (CHD) events in survivors of acute coronary
BACKGROUND Strategies for quantifying long-term risk of CHD events have gen
erally been confined to primary prevention settings. The Long-term Interven
tion with Pravastatin in Ischemic Disease (LIPID) study, which demonstrated
that pravastatin reduces CHD events in ACS survivors with a broad range of
cholesterol levels, enabled assessment of long-term prognosis in a seconda
ry prevention setting.
METHODS Based on outcomes in 8,557 patients in the LIPID study, a multivari
ate risk factor model was developed for prediction of CHD death or nonfatal
myocardial infarction. Prognostic indexes were developed based on the mode
l, and low-, medium-, high- and very high-risk groups were defined by categ
orizing the prognostic indexes.
RESULTS In addition to pravastatin treatment, the independently significant
risk factors included: total and high density lipoprotein cholesterol, age
, gender, smoking status, qualifying ACS, prior coronary revascularization,
diabetes mellitus, hypertension and prior stroke. Pravastatin reduced coro
nary event rates in each risk level, and the relative risk reduction did no
t vary significantly between risk levels. The predicted five-year coronary
event rates ranged from 5% to 19% for those assigned pravastatin and from 6
.4% to 23.6% fur those assigned placebo.
CONCLUSIONS Long-term prognosis of ACS survivors varied substantially accor
ding to conventional risk factor profile. Pravastatin reduced coronary risk
within all risk levels; however, absolute risk remained high in treated pa
tients with unfavorable profiles. Our risk stratification strategy enables
identification of ACS survivors who remain at very high risk despite statin
therapy. CT Am Coil Cardiol 2001;38:56-63) (C) 2001 by the American Colleg
e of Cardiology.