title: Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial.
abstract: BACKGROUND
  Evidence-based treatment for hypercholesterolaemia in Japan has been hindered by the lack of direct evidence in this population. Our aim was to assess whether evidence for treatment with statins derived from western populations can be extrapolated to the Japanese population.
  
  
  METHODS
  In this prospective, randomised, open-labelled, blinded study, patients with hypercholesterolaemia (total cholesterol 5.69-6.98 mmol/L) and no history of coronary heart disease or stroke were randomly assigned diet or diet plus 10-20 mg pravastatin daily. The primary endpoint was the first occurrence of coronary heart disease. Statistical analyses were done by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00211705.
  
  
  RESULTS
  3966 patients were randomly assigned to the diet group and 3866 to the diet plus pravastatin group. Mean follow-up was 5.3 years. At the end of study, 471 and 522 patients had withdrawn, died, or been lost to follow-up in the diet and diet plus pravastatin groups, respectively. Mean total cholesterol was reduced by 2.1% (from 6.27 mmol/L to 6.13 mmol/L) and 11.5% (from 6.27 mmol/L to 5.55 mmol/L) and mean LDL cholesterol by 3.2% (from 4.05 mmol/L to 3.90 mmol/L) and 18.0% (from 4.05 mmol/L to 3.31 mmol/L) in the diet and the diet plus pravastatin groups, respectively. Coronary heart disease was significantly lower in the diet plus pravastatin group than in the diet alone group (66 events vs 101 events; HR 0.67, 95% CI 0.49-0.91; p=0.01). There was no difference in the incidence of malignant neoplasms or other serious adverse events between the two groups.
  
  
  CONCLUSIONS
  Treatment with a low dose of pravastatin reduces the risk of coronary heart disease in Japan by much the same amount as higher doses have shown in Europe and the USA.
authors.affiliation: Mitsukoshi Health and Welfare Foundation, Tokyo, Japan. nakamura@mhwf.or.jp
authors.forename: Haruo
authors.initials: H
authors.lastname: Nakamura
authors.forename: Kikuo
authors.initials: K
authors.lastname: Arakawa
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Itakura
authors.forename: Akira
authors.initials: A
authors.lastname: Kitabatake
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Goto
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Toyota
authors.forename: Noriaki
authors.initials: N
authors.lastname: Nakaya
authors.forename: Shoji
authors.initials: S
authors.lastname: Nishimoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Muranaka
authors.forename: Akira
authors.initials: A
authors.lastname: Yamamoto
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D018752:Diet, Fat-Restricted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000178:diet therapy / Q000188:drug therapy*; D007564:Japan; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use*
chemical_list: D000924:Anticholesteremic Agents; D017035:Pravastatin