Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial

G. J. Blauw, M. B. Murphy, L. E. M. Bollen, B. M. Buckley, S. M. Cobbe, I. Ford, A. Gaw, M. Hyland, J. W. Jukema, A. M. Kamper, P. W. MacFarlane, A. E. Meinders, John David Norrie, C. J. Packard, I. J. Perry, D. J. Stott, B. J. Sweeney, G. Twomey, R. G. J. Westendorp, PROPSER Study Grp

    Research output: Contribution to journalArticle

    2698 Citations (Scopus)

    Abstract

    Background Although statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged individuals, their efficacy and safety in elderly people is not fully established. Our aim was to test the benefits of pravastatin treatment in an elderly cohort of men and women with, or at high risk of developing, cardiovascular disease and stroke.

    Methods We did a randomised controlled trial in which we assigned 5804 men (n=2804) and women (n=3000) aged 70-82 years with a history of, or risk factors for, vascular disease to pravastatin (40 mg per day; n=2891) or placebo (n=2913). Baseline cholesterol concentrations ranged from 4.0 mmol/L to 9.0 mmol/L. Follow-up was 3.2 years on average and our primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Analysis was by intention-to-treat.

    Findings Pravastatin lowered LDL cholesterol concentrations by 34% and reduced the incidence of the primary endpoint to 408 events compared with 473 on placebo (hazard ratio 0.85, 95% CI 0.74-0.97, p=0.014). Coronary heart disease death and non-fatal myocardial infarction risk was also reduced (0.81, 0.69-0.94, p=0.006). Stroke risk was unaffected (1.03, 0.81-1.31, p=0.8), but the hazard ratio for transient ischaemic attack was 0.75 (0.55-1.00, p=0.051). New cancer diagnoses were more frequent on pravastatin than on placebo (1.25, 1.04-1.51, p=0.020). However, incorporation of this finding in a meta-analysis of all pravastatin and all statin trials showed no overall increase in risk. Mortality from coronary disease fell by 24% (p=0.043) in the pravastatin group. Pravastatin had no significant effect on cognitive function or disability.

    Interpretation Pravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore extends to elderly individuals the treatment strategy currently used in middle aged people.

    Original languageEnglish
    Pages (from-to)1623-1630
    Number of pages7
    JournalThe Lancet
    Volume360
    Issue number9346
    DOIs
    Publication statusPublished - Nov 2002

    Keywords

    • CORONARY HEART-DISEASE
    • AVERAGE CHOLESTEROL LEVELS
    • MYOCARDIAL-INFARCTION
    • MORTALITY
    • EVENTS
    • PREVENTION
    • PREVALENCE
    • ROTTERDAM
    • DEMENTIA
    • STATINS

    Cite this

    Blauw, G. J., Murphy, M. B., Bollen, L. E. M., Buckley, B. M., Cobbe, S. M., Ford, I., ... PROPSER Study Grp (2002). Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial. The Lancet, 360(9346), 1623-1630. https://doi.org/10.1016/S0140-6736(02)11600-X

    Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial. / Blauw, G. J.; Murphy, M. B.; Bollen, L. E. M.; Buckley, B. M.; Cobbe, S. M.; Ford, I.; Gaw, A.; Hyland, M.; Jukema, J. W.; Kamper, A. M.; MacFarlane, P. W.; Meinders, A. E.; Norrie, John David; Packard, C. J.; Perry, I. J.; Stott, D. J.; Sweeney, B. J.; Twomey, G.; Westendorp, R. G. J.; PROPSER Study Grp.

    In: The Lancet, Vol. 360, No. 9346, 11.2002, p. 1623-1630.

    Research output: Contribution to journalArticle

    Blauw, GJ, Murphy, MB, Bollen, LEM, Buckley, BM, Cobbe, SM, Ford, I, Gaw, A, Hyland, M, Jukema, JW, Kamper, AM, MacFarlane, PW, Meinders, AE, Norrie, JD, Packard, CJ, Perry, IJ, Stott, DJ, Sweeney, BJ, Twomey, G, Westendorp, RGJ & PROPSER Study Grp 2002, 'Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial', The Lancet, vol. 360, no. 9346, pp. 1623-1630. https://doi.org/10.1016/S0140-6736(02)11600-X
    Blauw, G. J. ; Murphy, M. B. ; Bollen, L. E. M. ; Buckley, B. M. ; Cobbe, S. M. ; Ford, I. ; Gaw, A. ; Hyland, M. ; Jukema, J. W. ; Kamper, A. M. ; MacFarlane, P. W. ; Meinders, A. E. ; Norrie, John David ; Packard, C. J. ; Perry, I. J. ; Stott, D. J. ; Sweeney, B. J. ; Twomey, G. ; Westendorp, R. G. J. ; PROPSER Study Grp. / Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial. In: The Lancet. 2002 ; Vol. 360, No. 9346. pp. 1623-1630.
    @article{147cba1602b94233a70f78a45695b7ca,
    title = "Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial",
    abstract = "Background Although statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged individuals, their efficacy and safety in elderly people is not fully established. Our aim was to test the benefits of pravastatin treatment in an elderly cohort of men and women with, or at high risk of developing, cardiovascular disease and stroke.Methods We did a randomised controlled trial in which we assigned 5804 men (n=2804) and women (n=3000) aged 70-82 years with a history of, or risk factors for, vascular disease to pravastatin (40 mg per day; n=2891) or placebo (n=2913). Baseline cholesterol concentrations ranged from 4.0 mmol/L to 9.0 mmol/L. Follow-up was 3.2 years on average and our primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Analysis was by intention-to-treat.Findings Pravastatin lowered LDL cholesterol concentrations by 34{\%} and reduced the incidence of the primary endpoint to 408 events compared with 473 on placebo (hazard ratio 0.85, 95{\%} CI 0.74-0.97, p=0.014). Coronary heart disease death and non-fatal myocardial infarction risk was also reduced (0.81, 0.69-0.94, p=0.006). Stroke risk was unaffected (1.03, 0.81-1.31, p=0.8), but the hazard ratio for transient ischaemic attack was 0.75 (0.55-1.00, p=0.051). New cancer diagnoses were more frequent on pravastatin than on placebo (1.25, 1.04-1.51, p=0.020). However, incorporation of this finding in a meta-analysis of all pravastatin and all statin trials showed no overall increase in risk. Mortality from coronary disease fell by 24{\%} (p=0.043) in the pravastatin group. Pravastatin had no significant effect on cognitive function or disability.Interpretation Pravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore extends to elderly individuals the treatment strategy currently used in middle aged people.",
    keywords = "CORONARY HEART-DISEASE, AVERAGE CHOLESTEROL LEVELS, MYOCARDIAL-INFARCTION, MORTALITY, EVENTS, PREVENTION, PREVALENCE, ROTTERDAM, DEMENTIA, STATINS",
    author = "Blauw, {G. J.} and Murphy, {M. B.} and Bollen, {L. E. M.} and Buckley, {B. M.} and Cobbe, {S. M.} and I. Ford and A. Gaw and M. Hyland and Jukema, {J. W.} and Kamper, {A. M.} and MacFarlane, {P. W.} and Meinders, {A. E.} and Norrie, {John David} and Packard, {C. J.} and Perry, {I. J.} and Stott, {D. J.} and Sweeney, {B. J.} and G. Twomey and Westendorp, {R. G. J.} and {PROPSER Study Grp}",
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    month = "11",
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    language = "English",
    volume = "360",
    pages = "1623--1630",
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    TY - JOUR

    T1 - Pravastatin in elderly individuals at risk of vascular disease (PROSPER) : a randomised controlled trial

    AU - Blauw, G. J.

    AU - Murphy, M. B.

    AU - Bollen, L. E. M.

    AU - Buckley, B. M.

    AU - Cobbe, S. M.

    AU - Ford, I.

    AU - Gaw, A.

    AU - Hyland, M.

    AU - Jukema, J. W.

    AU - Kamper, A. M.

    AU - MacFarlane, P. W.

    AU - Meinders, A. E.

    AU - Norrie, John David

    AU - Packard, C. J.

    AU - Perry, I. J.

    AU - Stott, D. J.

    AU - Sweeney, B. J.

    AU - Twomey, G.

    AU - Westendorp, R. G. J.

    AU - PROPSER Study Grp

    PY - 2002/11

    Y1 - 2002/11

    N2 - Background Although statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged individuals, their efficacy and safety in elderly people is not fully established. Our aim was to test the benefits of pravastatin treatment in an elderly cohort of men and women with, or at high risk of developing, cardiovascular disease and stroke.Methods We did a randomised controlled trial in which we assigned 5804 men (n=2804) and women (n=3000) aged 70-82 years with a history of, or risk factors for, vascular disease to pravastatin (40 mg per day; n=2891) or placebo (n=2913). Baseline cholesterol concentrations ranged from 4.0 mmol/L to 9.0 mmol/L. Follow-up was 3.2 years on average and our primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Analysis was by intention-to-treat.Findings Pravastatin lowered LDL cholesterol concentrations by 34% and reduced the incidence of the primary endpoint to 408 events compared with 473 on placebo (hazard ratio 0.85, 95% CI 0.74-0.97, p=0.014). Coronary heart disease death and non-fatal myocardial infarction risk was also reduced (0.81, 0.69-0.94, p=0.006). Stroke risk was unaffected (1.03, 0.81-1.31, p=0.8), but the hazard ratio for transient ischaemic attack was 0.75 (0.55-1.00, p=0.051). New cancer diagnoses were more frequent on pravastatin than on placebo (1.25, 1.04-1.51, p=0.020). However, incorporation of this finding in a meta-analysis of all pravastatin and all statin trials showed no overall increase in risk. Mortality from coronary disease fell by 24% (p=0.043) in the pravastatin group. Pravastatin had no significant effect on cognitive function or disability.Interpretation Pravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore extends to elderly individuals the treatment strategy currently used in middle aged people.

    AB - Background Although statins reduce coronary and cerebrovascular morbidity and mortality in middle-aged individuals, their efficacy and safety in elderly people is not fully established. Our aim was to test the benefits of pravastatin treatment in an elderly cohort of men and women with, or at high risk of developing, cardiovascular disease and stroke.Methods We did a randomised controlled trial in which we assigned 5804 men (n=2804) and women (n=3000) aged 70-82 years with a history of, or risk factors for, vascular disease to pravastatin (40 mg per day; n=2891) or placebo (n=2913). Baseline cholesterol concentrations ranged from 4.0 mmol/L to 9.0 mmol/L. Follow-up was 3.2 years on average and our primary endpoint was a composite of coronary death, non-fatal myocardial infarction, and fatal or non-fatal stroke. Analysis was by intention-to-treat.Findings Pravastatin lowered LDL cholesterol concentrations by 34% and reduced the incidence of the primary endpoint to 408 events compared with 473 on placebo (hazard ratio 0.85, 95% CI 0.74-0.97, p=0.014). Coronary heart disease death and non-fatal myocardial infarction risk was also reduced (0.81, 0.69-0.94, p=0.006). Stroke risk was unaffected (1.03, 0.81-1.31, p=0.8), but the hazard ratio for transient ischaemic attack was 0.75 (0.55-1.00, p=0.051). New cancer diagnoses were more frequent on pravastatin than on placebo (1.25, 1.04-1.51, p=0.020). However, incorporation of this finding in a meta-analysis of all pravastatin and all statin trials showed no overall increase in risk. Mortality from coronary disease fell by 24% (p=0.043) in the pravastatin group. Pravastatin had no significant effect on cognitive function or disability.Interpretation Pravastatin given for 3 years reduced the risk of coronary disease in elderly individuals. PROSPER therefore extends to elderly individuals the treatment strategy currently used in middle aged people.

    KW - CORONARY HEART-DISEASE

    KW - AVERAGE CHOLESTEROL LEVELS

    KW - MYOCARDIAL-INFARCTION

    KW - MORTALITY

    KW - EVENTS

    KW - PREVENTION

    KW - PREVALENCE

    KW - ROTTERDAM

    KW - DEMENTIA

    KW - STATINS

    U2 - 10.1016/S0140-6736(02)11600-X

    DO - 10.1016/S0140-6736(02)11600-X

    M3 - Article

    VL - 360

    SP - 1623

    EP - 1630

    JO - The Lancet

    JF - The Lancet

    SN - 0140-6736

    IS - 9346

    ER -