ABSTRACT
Frank M. Sacks,1 Marc A. Pfeffer,2 Lemuel A. Moye,3 C. Morton Hawkins,3 Barry R. Davis,3 Jean L. Rouleau,4 Thomas G. Cole,5 and Eugene Braunwald2 for the CARE Trial Investigators 1Harvard School of Public Health, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts; 2Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; 3University of Texas School of Public Health, Houston, Texas; 4University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada; 5 Washington University, St. Louis, Missouri
I. INTRODUCTION
Plasma total and LDL cholesterol are predictors of initial or recurrent coronary heart disease (1-4), and lowering LDL cholesterol from elevated levels prevents recurrent coronary events (5-8). However, epidemiological studies show that the relationship between plasma cholesterol and coronary events is stronger in elevated than in average ranges (1-4). Prior to the CARE trial, it had not been clear whether coronary events can be prevented by cholesterol-lowering therapy in patients who did not have hypercholesterolemia. This is an important public health issue because the large majority of patients with coronary disease have total cholesterol and LDL levels in the average, not elevated, range (9-12), similar to that of the general population (13) (Fig. 1). The CARE trial specifically studied whether pravastatin, an inhibitor of HMG CoA reductase, could prevent recurrent coronary events and stroke in a typical postmyocardial infarction population with plasma total cholesterol <240 mg/dL (6.2 mmol/L), and LDL cholesterol levels 115-174 mg/dL (3.0-4.5 mmol/L).
