Lipid-lowering
therapy in individuals with high risk of
cardiovascular disease reduces the incidence of
coronary heart disease. However, few studies have assessed the benefits of
cholesterol lowering for primary prevention of
coronary heart disease in hypertensive patients with mild
dyslipidemia or without conventional
dyslipidemia. The large, randomized Management of
Elevated Cholesterol in the Primary Prevention Group of Adult Japanese Study showed a 33% reduction in
coronary heart disease incidence with
pravastatin as the primary prevention in Japanese patients. We conducted an exploratory analysis of the effect of diet plus
pravastatin therapy on the primary prevention of cardiovascular events (
coronary heart disease,
coronary heart disease plus
cerebral infarction, and
cardiovascular disease) in the 3277 patients with
hypertension during the 5-year follow-up. There were no significant differences in mean baseline total
cholesterol, blood pressure levels, or variation in blood pressure during the 5-year period between the diet (n=1664) and diet plus
pravastatin (n=1613) groups. In the diet plus
pravastatin group, the relative risk of
coronary heart disease plus
cerebral infarction was reduced by 35% (hazard ratio: 0.65; CI: 0.46 to 0.93; P=0.02),
cerebral infarction by 46% (hazard ratio: 0.54; CI: 0.29 to 0.98; P=0.04), and
cardiovascular disease by 33% (hazard ratio: 0.67; CI: 0.49 to 0.91; P=0.01). In patients without a history of
cardiovascular disease who have
hypertension and mildly
elevated cholesterol,
pravastatin was effective in reducing the incidence of
cardiovascular disease, particularly
cerebral infarction. Hence, in patients with
hypertension with mildly
elevated cholesterol levels, treatment with a
statin is advisable to reduce the burden of
cardiovascular disease.