Author + information
- Received October 10, 2000
- Revision received March 22, 2001
- Accepted April 5, 2001
- Published online July 1, 2001.
- Ian C Marschner, PhDa,* (, )
- David Colquhoun, MD†,
- R.John Simes, MDa,
- Paul Glasziou, MD, PhD‡,
- Philip Harris, MD§,
- Bhuwan B Singh, MD∥,
- Denis Friedlander, MD¶,
- Harvey White, MD, DSc#,
- Peter Thompson, MD∗∗,
- Andrew Tonkin, MD††,
- on behalf of the LIPID Study Investigators
- ↵*Reprint requests and correspondence:
Dr. Ian Marschner, NHMRC Clinical Trials Center, Level 5, Building F, 88 Mallett Street, P.O.B. Locked Bag 77, Camperdown, NSW 2050, Australia
We developed a prognostic strategy for quantifying the long-term risk of coronary heart disease (CHD) events in survivors of acute coronary syndromes (ACS).
Strategies for quantifying long-term risk of CHD events have generally been confined to primary prevention settings. The Long-term Intervention 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 secondary prevention setting.
Based on outcomes in 8,557 patients in the LIPID study, a multivariate risk factor model was developed for prediction of CHD death or nonfatal myocardial infarction. Prognostic indexes were developed based on the model, and low-, medium-, high- and very high-risk groups were defined by categorizing the prognostic indexes.
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 coronary event rates in each risk level, and the relative risk reduction did not 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% for those assigned placebo.
Long-term prognosis of ACS survivors varied substantially according to conventional risk factor profile. Pravastatin reduced coronary risk within all risk levels; however, absolute risk remained high in treated patients with unfavorable profiles. Our risk stratification strategy enables identification of ACS survivors who remain at very high risk despite statin therapy.
☆ Supported by a grant from the Bristol-Myers Squibb Pharmaceutical Research Institute, Princeton, New Jersey, and conducted under the auspices of the National Heart Foundation of Australia.
- Received October 10, 2000.
- Revision received March 22, 2001.
- Accepted April 5, 2001.
- American College of Cardiology