Cholesterol and Recurrent Events CARE study

TE, Moye LA, Piller LB, Rutherford J, Simpson LM, Braunwald 107. E. Reduction of stroke incidence after myocardial infarction with pravastatin the Cholesterol and Recurrent Events (CARE) study. 108. The Care Investigators. Circulation 1999 99 216-223. 

With the advent of the statin class of drugs, lowering of low density lipoprotein (LDL) cholesterol to a meaningful degree became clinically achievable in most patients with vascular disease. There have been three large trials of statins in secondary prevention of MI (61) the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) study, the Cholesterol and Recurrent Events (CARE) study, and the Scandinavian... 

The purpose of altering plasma lipoprotein levels is to reduce the risk of coronary events. The results of outcome trials are available for lovastatin (Downs et al, 1998), simvastatin (Scandinavian Simvastatin Survival Study Group 1994), and pravastatin (Shepherd et al, 1995 Sacks et al, 1996 The Long-Term Intervention With Pravastatin in Ischaemic Disease (LIPID) Study Group, 1998). Three of these trials, 4S, Cholesterol and Recurrent Events (CARE), and LIPID, studied patients with CHD, whereas the West of Scotland Coronary Revention Study Group and the Air Force Coronary Atherosclesosis Prevention Study (AFCAPS) evaluated the benefits of therapy in patients without known CHD. The main results of these trials are summarized in Tables la and lb. 

The ability of statins to lower hsCRP was first described for pravastatin using data accumulated in the Cholesterol and Recurrent Events (CARE) trial. These data were initially highly controversial because they suggested that statins have both hpid-lowering and antiinflammatory effects. However, confirmatory work rapidly showed the effect of statins on hsCRP to be a consistent and important class effect. Studies of atorvastatin, cerivastatin, lovastatin, pravastatin, and simvastatin have shown that, on average, median hsCRP concentrations decline 15% to 25% as early as 6 weeks after initiation of therapy. Importantly the magnitude of LDL cholesterol reduction caused by statin therapy is minimally correlated with the magnitude of hsCRP reduction. ... 

FU, follow-up P, interaction between placebo and statin therapy NR, not reported RR, relative risk Cl, confidence interval 4S, Scandinavian Simvastatin Survival Study REGRESS, Regression Growth Evaluation Statin Study CARE, Cholesterol and Recurrent Events CETP, Cholestery 1 ester transfer protein GP, glycoprotein CV, cardiovascular MI, myocardial infarction. 

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