Association between lowering low-density lipoprotein cholesterol with pravastatin and primary prevention of cardiovascular disease in mild to moderate hypercholesterolemic japanese

Aims: to evaluate the relationship between low-density lipoprotein cholesterol (ldl-c) change and reduction of cardiovascular disease in the management of elevated cholesterol in the primary prevention group of adult japanese (mega) study. &methods: patients in the diet plus pravastatin group were divided into tertiles by their on-treatment ldl-c level,and the hazard ratios (hrs) in each tertile were compared with the diet group at 5 years using the cox proportional hazards model. in addition,the treatment groups were combined and divided into quintiles according to the on-treatment ldl-c level during follow-up,and the incidence of cardiovascular events was compared among the 5 groups. &results: in the tertiles of the diet plus pravastatin group,hr was lowest in the second tertile against the diet group (hr 0.57,p =0.01) with on-treatment ldl-c range of 119.8-133.4 mg/dl. in the analysis of quintiles of the total population,a significant risk reduction of cvd was found in the fourth quintile (hr 0.48,p = 0.0015) with an on-treatment ldl-c range of 120.9-133.3 mg/dl,and in the fifth quintile (hr 0.64,p =0.048) with an on-treatment ldl-c range of 56.7-120.8 mg/dl against tertile 1 with an on-treatment ldl-c range of 157.5-206.2 mg/dl. &conclusions: the usual japanese dose of pravastatin therapy is sufficient in this low-risk patient population to reduce cardiovascular risk,with an achieved ldl-c level <133.4 mg/dl. further risk reduction was not found with an achieved ldl <120 mg/dl.