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CLINICAL STUDIES

The effects of pravastatin on hospital admission in hypercholesterolemic middle-aged men

West of Scotland Coronary Prevention Study

^a Departments of Medical Cardiology, Medicine and Pathological Biochemistry and Statistics, University of Glasgow, Royal Infirmary, Glasgow, United Kingdom

Manuscript received April 1, 1998; revised manuscript received September 18, 1998, accepted December 4, 1998.

Reprint requests and correspondence: Dr. Stuart M. Cobbe, Department of Medical Cardiology, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, United Kingdom.
stuart.cobbe{at}clinmed.gla.ac.uk

OBJECTIVES

The purpose of the study was to assess the effect of lipid reduction with pravastatin on hospital admissions in middle-aged men with hypercholesterolemia in the West of Scotland Coronary Prevention Study.

BACKGROUND

A prospective, randomized controlled trial was undertaken in primary care centers in the West of Scotland.

METHODS

A total of 6,595 participants randomized to receive pravastatin 40 mg or placebo daily were followed up for a mean of 4.9 years (range 3.5 to 6.1 years). Analysis of hospital admissions was undertaken according to the "intention to treat" principle both for cardiovascular diseases and noncardiovascular diseases (including malignant neoplasms, psychiatric diagnoses, trauma and other causes). A secondary analysis of hospitalization in patients who were 75% compliant was performed.

RESULTS

During the trial, 2,198 (33%) of the 6,595 men were admitted to hospital on 4,333 occasions, of which 1,234 (28%) were for cardiovascular causes. Pravastatin reduced the number of subjects requiring hospital admission for cardiovascular causes by 21% (95% CI [confidence interval] 9 to 31, p = 0.0008) overall, and by 27% (95% CI 15 to 38) in compliant participants. The number of admissions per 1,000 subject-years for cardiovascular disease was reduced by 10.8 (95% CI 4 to 17.4, p = 0.0013) in all subjects, and by 15.6 (95% CI 8.3 to 23, p < 0.0001) in compliant participants. Pravastatin had no significant influence on hospital admission for any noncardiovascular diagnostic category. There were 13.4 fewer admissions per 1,000 subject-years for all causes in the pravastatin-treated group (95% CI –0.4 to 27.3, p = 0.076). No significant difference in duration of hospital stay was found between the pravastatin and placebo patients in any diagnostic group.

CONCLUSIONS

Pravastatin therapy reduced the burden of hospital admissions for cardiovascular disease, without any adverse effect on noncardiovascular hospitalization.

Abbreviations and Acronyms   CHD = coronary heart disease   CI = confidence interval   ICD 8 = International Classification of Diseases 8th Revision   MI = myocardial infarction   OPCS 4 = Office of Population Censuses and Surveys Revision 4 coding   WOSCOPS = West of Scotland Coronary Prevention Study

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