Slide Source: Lipids Online Slide Library www.lipidsonline.org Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT)

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P Sever (Co-chair), B Dahlöf (Co-chair), N Poulter (Secretary), H Wedel (Statistician), G Beevers, M Caulfield, R Collins, SE Kjeldsen, A Kristinsson,

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Presentation transcript:

Slide Source: Lipids Online Slide Library Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT) 10,355 ambulatory patients age 55 years, with LDL-C 120–189 mg/dL (100–129 mg/dL in patients with known CHD) and TG <350 mg/dL Randomized to open-label pravastatin 40 mg/d or usual care Primary outcome: all-cause mortality Secondary outcomes: nonfatal MI or fatal CHD, cause-specific mortality, and cancer Follow-up 4.8 years (mean) ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007.

Slide Source: Lipids Online Slide Library Patients (%) Year 2 Pravastatin ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007. Copyright ©2002, American Medical Association. Use of Pravastatin in Pravastatin Patients and Nonstudy Statins in Placebo Patients: ALLHAT-LLT Usual Care Year 4Year

Slide Source: Lipids Online Slide Library LDL-C at Baseline and during Follow-up: ALLHAT-LLT ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007. Copyright ©2002, American Medical Association. LDL-C (mg/dl) Measured in 10% of pravastatin and 5% of usual care patients: Pravastatin Usual care Year 2Year 4Year 6Baseline –6.9% –11.0% –16.2% –23.4% –27.7% –30.1% PravastatinUsual Care

Slide Source: Lipids Online Slide Library Mortality by Cause: ALLHAT-LLT Cause of death Events over 6 years (%) Relative risk (95% CI)p Pravastatin (n=5170) Usual care (n=5185) Total (1°)631 (14.9)641 (15.3)0.99 (0.89–1.11).88 CVD295 (6.9)300 (7.1)0.99 (0.84–1.16).91 CHD160 (3.7)162 (3.9)0.99 (0.80–1.24).96 Stroke53 (1.2)56 (1.4)0.95 (0.66–1.39).81 Other CVD82 (2.1)82 (2.0)1.01 (0.74–1.37).96 Non-CVD302 (7.7)302 (7.8)1.01 (0.86–1.18).92 Cancer163 (4.1)148 (3.7)1.11 (0.89–1.39).36 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007.

Slide Source: Lipids Online Slide Library Major Outcomes: ALLHAT-LLT Outcome Events (6-yr rate/100 patients) Relative risk (95% CI)p Pravastatin (n=5170) Usual care (n=5185) Primary endpoint Total deaths631 (14.9)641 (15.3)0.99 (0.89–1.11).88 Secondary endpoints CHD events*380 (9.3)421 (10.4)0.91 (0.79–1.04).16 Cancer378 (9.6)369 (9.3)1.03 (0.89–1.19).66 Other endpoints Stroke209 (5.3)231 (5.8)0.91 (0.75–1.09).31 Heart failure243 (6.0)248 (6.2)0.99 (0.83–1.18).89 ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007. *Nonfatal MI or CHD death

Slide Source: Lipids Online Slide Library CHD Death Plus Nonfatal MI Cumulative Rate, % Pravastatin Usual Care Kaplan–Meier Curves for All-Cause Mortality and CHD Events: ALLHAT-LLT ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007. Copyright ©2002, American Medical Association. No. at Risk Pravastatin Usual Care Time to Death, y RR (95% CI), 0.99 ( ) All-Cause Mortality Pravastatin Usual Care RR (95% CI), 0.91 ( )

Slide Source: Lipids Online Slide Library Reductions in CHD Event Rates by Total Cholesterol Differential in Statin Trials % Change in Total Cholesterol (Control – Treatment) In OR Post-CABG LIPID AFCAPS CARE WOSCOPS HPS LIPS 4S Regression line from meta-analyses of 45 long-term trials of statin and other cholesterol-lowering interventions ALLHAT-LLT CHD Events ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288:2998–3007. Copyright ©2002, American Medical Association.