Antihypertensive and LipidLowering Treatment to Prevent Heart Attack Trial JAMA 200228829983007 ALLHAT LLT 10355 patients with moderate hypercholesterolemia All patients enrolled in the ALLHAT antihypertensive trial ID: 564100
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Lipid Lowering Substudy Trial of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial
JAMA 2002;288:2998-3007
ALLHAT- LLTSlide2
10,355 patients with moderate hypercholesterolemia
All patients enrolled in the ALLHAT antihypertensive trial
Fasting LDL-C level of 120-189 mg/dL with no known CHD
or
100-129 mg/dL with known CHDFasting triglyceride levels <350 mg/dL NHLBI funded trial
Endpoints:Primary – All-cause mortality Fatal coronary heart disease and nonfatal MISecondary – Fatal coronary heart disease and nonfatal MI, stroke, CHF, cancerMean follow-up 4.8 years
ALLHAT- LLT
JAMA 2002;288:2998-3007
Pravastatin 40 mg/day(n=5,170)
Usual Care
at discretion of primary care physician
(n=5,185)Slide3
All Cause Mortality
RR = 0.99
p = 0.88
ALLHAT- LLT: Clinical Endpoints
Pravastatin
Usual Care
Fatal Heart Disease
or Nonfatal MI
RR = 0.91p = 0.16
Stroke
RR = 0.91
p = 0.31
JAMA 2002;288:2998-3007
Pravastatin
Usual Care
Pravastatin
Usual CareSlide4
Pravastatin
17.2%
ALLHAT- LLT: Total Cholesterol
Baseline
4 Year Follow-upUsual Care 7.6%
mg/dL
Baseline
4 Year Follow-up
JAMA 2002;288:2998-3007
mg/dLSlide5
Pravastatin
2
7.7%
ALLHAT- LLT: LDL Cholesterol
Baseline
4 Year Follow-upUsual Care 11.0%
mg/dL
Baseline
4 Year Follow-up
JAMA 2002;288:2998-3007
mg/dLSlide6
ALLHAT- LLT: SummaryDespite moderate reduction in cholesterol with pravastatin, there was no difference in mortality, CHD or stroke compared with usual care for moderate hypercholesterolemia
High crossover rate from usual care to statin treatment (8% at year 2 and 17% at year 4) may explain the only moderate difference in cholesterol reduction and the lack of clinical benefit between the two armsA greater benefit was observed in blacks than in nonblacks with pravastatin for fatal heart disease or nonfatal MI endpoint (RR 0.73 vs 1.02, p=0.03)
Lack of clinical benefit with statin therapy contrasts with other large statin trials (4S, CARE, LIPID, and PROSPER)Meta-analysis of 9 large statin trials including ALLHAT-LLT shows CHD events 27% and mortality
14% with statin therapy