Pravastatin - A review of its use in elderly patients

Pravastatin (Pravachol((R)))) is a competitive, reversible HMG-CoA reductase inhibitor that lowers serum cholesterol levels by inhibiting de novo cholesterol synthesis and has antiatherogenic effects that appear to be partially independent of its lipid-lowering effects. Pravastatin 10-40 mg/day produced significant reductions (vs baseline or placebo) in serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in elderly patients (aged greater than or equal to60 or greater than or equal to 65 years) with hypercholesterolaemia or normal cholesterol levels. Serum triglyceride and high-density lipoprotein cholesterol levels also improved in some studies, but not in others. Coadministration of cholestyramine, another lipid-lowering agent, further enhanced the lipid-lowering effects of pravastatin in elderly patients. Data from the large, long-term (3-6 years) PROspective Study Of Pravastatin in the Elderly at Risk (PROSPER), Cholesterol And Recurrent Events trial (CARE) and Long term Intervention with Pravastatin in Ischaemic Disease (LIPID) trials demonstrated that pravastatin 40 mg/day reduces coronary events in elderly patients with hypercholesterolaemia or normal cholesterol levels, with or at high risk of developing coronary heart disease (CHD). In these trials, the incidence of death from CHD or the combined endpoint of death from CHD or nonfatal myocardial infarction was significantly lower in pravastatin than in placebo recipients. Pravastatin is well tolerated in the elderly, and adverse effects considered related to therapy are minimal. The most commonly occurring adverse events included gastrointestinal events, renal or genital system events, respiratory disorders, headaches and musculoskeletal pain. Conclusion: Pravastatin effectively lowers serum TC and LDL-C levels and, as demonstrated in major clinical outcome trials, reduces coronary events in elderly patients with hypercholesterolaemia or normal cholesterol levels. Pravastatin is well tolerated and as such should be considered a first-line agents for primary or secondary prevention in older individuals with evident CHD or multiple risk factors for CHD.