Trial reanalysis links pravastatin adherence to fewer deaths
A reanalysis estimated 3.0 percentage points lower five-year death risk with full adherence to pravastatin versus usual care.
Our read
Interventions- Studied:
- Randomized trial in 9,741 older adults with hypertension and moderately elevated cholesterol, 5 years (Multicenter)
- What changed:
- Death risk was 21% lower under full pravastatin adherence than with usual care
- The catch:
- Missing contraindication data could misclassify appropriate pravastatin discontinuations as nonadherence
- In the record:
- The 17th paper on pravastatin with results in people; 57 on record in all. Its result on mortality agrees with 2 of 3 other findings on record; 1 found no change.
- Why it’s aging research:
- It studies an intervention with evidence of extending healthy life.
Editor of record: Boris Djordjevic · AgingResearch.News
A reanalysis of an unblinded randomized trial included 9,741 men and women aged 55 or older with high blood pressure and moderately elevated cholesterol. Their average age was 66, and 52% were male. All had another heart disease risk factor. Participants received pravastatin, starting at 20 mg and increasing to 40 mg daily as needed, or usual care, which discouraged cholesterol-lowering drugs unless clinically indicated.
One-third of the pravastatin group did not follow the assigned strategy by year five. After adjusting for factors related to adherence, researchers estimated a 3.0-percentage-point lower five-year risk of death with full adherence versus usual care. The adherence strategy allowed stopping pravastatin for side effects or other specified circumstances. Assignment to pravastatin alone did not clearly lower death risk.
Why it matters
For older adults with cardiovascular risk factors, the analysis addressed whether following a prescribed drug strategy could affect survival differently from simply being assigned to it.
Caveats
The full-adherence estimate depended on statistical adjustment and assumed that relevant factors affecting adherence and death were measured and modeled. The trial excluded people under 55 and those with significant liver or kidney disease.
From the paper
- Result
The intention-to-treat HR for death comparing pravastatin and usual care was 0.99 (95% CI, 0.89–1.11) in the entire sample (same as reported previously) and 0.96 (95% CI, 0.85–1.08) in the subset of individuals with complete baseline data.
- Harms
… and when prohibiting lipid-lowering treatment under any circumstances in the usual care arm (73%) and only allowing individuals in the pravastatin arm to discontinue in the presence of adverse events (65%).
- Limitation
Although LDL-C is more frequently used than total cholesterol to prescribe lipid-lowering therapy, we used total cholesterol as an adjustment variable and part of the usual care treatment strategy (ie, initiation when cholesterol ≥ 240 mg/dL) since LDL-C, HDL-C …
Quoted word for word from the full text on PubMed Central.
The paper
Harvard University
American Journal of Epidemiology, Mar 6, 2026, Open access
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