title: Long-Term Effectiveness and Safety of Pravastatin in Patients With Coronary Heart Disease: Sixteen Years of Follow-Up of the LIPID Study.
abstract: We aimed to assess the long-term effects of treatment with statin therapy on all-cause mortality, cause-specific mortality, and cancer incidence from extended follow-up of the Long-term Intervention with Pravastatin in Ischemic Disease (LIPID) trial.
  
  
  
  LIPID initially compared pravastatin and placebo over 6 years in 9014 patients with previous coronary heart disease. After the double-blind period, all patients were offered open-label statin therapy. Data were obtained over a further 10 years from 7721 patients, by direct contact for 2 years, by questionnaires thereafter, and from mortality and cancer registries. During extended follow-up, 85% assigned pravastatin and 84% assigned placebo took statin therapy. Patients assigned pravastatin maintained a significantly lower risk of death from coronary heart disease (relative risk [RR] 0.89; 95% confidence interval [CI], 0.81-0.97; P=0.009), from cardiovascular disease (RR, 0.88; 95% CI, 0.81-0.95; P=0.002), and from any cause (RR, 0.91; 95% CI, 0.85-0.97; absolute risk reduction, 2.6%; P=0.003).Cancer incidence was similar by original treatment group during the double-blind period (RR, 0.94; 95% CI, 0.82-1.08; P=0.41), later follow-up (RR, 1.02; 95% CI, 0.91-1.14; P=0.74), and overall (RR, 0.99; 95% CI, 0.91-1.08; P=0.83). There were no significant differences in cancer mortality, or in the incidence of organ-specific cancers. Cancer findings were confirmed in a meta-analysis with other large statin trials with extended follow-up.
  
  
  
  In LIPID, the absolute survival benefit from 6 years of pravastatin treatment appeared to be maintained for the next 10 years, with a similar risk of death among survivors in both groups after the initial period. Treatment with statins does not influence cancer or death from noncardiovascular causes during long-term follow-up.
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.) wendy@ctc.usyd.edu.au.
authors.forename: Wendy E
authors.initials: WE
authors.lastname: Hague
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: John
authors.initials: J
authors.lastname: Simes
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Adrienne
authors.initials: A
authors.lastname: Kirby
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Keech
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: David
authors.initials: D
authors.lastname: Hunt
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nestel
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: David M
authors.initials: DM
authors.lastname: Colquhoun
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Helen
authors.initials: H
authors.lastname: Pater
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Stewart
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: David R
authors.initials: DR
authors.lastname: Sullivan
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Peter L
authors.initials: PL
authors.lastname: Thompson
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Malcolm
authors.initials: M
authors.lastname: West
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Paul P
authors.initials: PP
authors.lastname: Glasziou
authors.affiliation: From National Health and Medical Research Council Clinical Trials Centre, University of Sydney, New South Wales, Australia (W.E.H., J.S., A.K., A.C.K., H.P.); Green Lane Cardiovascular Service, Auckland City Hospital, New Zealand (H.D.W., R.A.S.); Department of Cardiology, Royal Melbourne Hospital and University of Melbourne, Victoria, Australia (D.H.); Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia (P.J.N.); Greenslopes Hospital, Brisbane, Queensland, Australia (D.M.C.); Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (D.R.S.); University of Western Australia, Perth, Australia (P.L.T.); University of Queensland, Brisbane, Queensland, Australia (M.W.); Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia (P.P.G.); and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T.).
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Tonkin
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D015337:Multicenter Studies as Topic; D017035:Pravastatin / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017035:Pravastatin
keywords: cardiovascular diseases; cholesterol; coronary disease; hydroxymethylglutaryl-CoA reductase inhibitors; lipids