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(Hypertension. 2009;53:135.)
© 2009 American Heart Association, Inc.

Original Articles

Pravastatin for Cardiovascular Event Primary Prevention in Patients With Mild-to-Moderate Hypertension in the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) Study

Toshio Kushiro; Kyoichi Mizuno; Noriaki Nakaya; Yasuo Ohashi; Naoko Tajima; Tamio Teramoto; Shinichiro Uchiyama; Haruo Nakamura for the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese Study Group

From the Health Planning Center (T.K.), Nihon University School of Medicine; Department of Internal Medicine (K.M.), Nippon Medical School; Department of Internal Medicine (N.N.), Nakaya Clinic; Department of Biostatistics/Epidemiology and Preventive Health Sciences (Y.O.), University of Tokyo; Department of Internal Medicine (N.T.), Jikei University School of Medicine; Department of Internal Medicine (T.T.), Teikyo University School of Medicine; Department of Neurology (S.U.), Tokyo Women’s Medical University; and Mitsukoshi Health and Welfare Foundation (H.N.), Tokyo, Japan.

Correspondence to Toshio Kushiro, Nihon University School of Medicine, Health Planning Center, 1-7-3, Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062 Japan. E-mail kushiro{at}med.nihon-u.ac.jp

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.

Key Words: hypertension • hypercholesterolemia • diet • pravastatin • cardiovascular diseases

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