By William J. Cromie

Gazette Staff

A widely used cholesterol-lowering drug can reduce stroke risk and death from heart disease in patients without high cholesterol. That's the conclusion of the first long-term evaluation of pravastatin done by researchers from the Medical School, Brigham and Women's Hospital, and several other centers in the United States and Canada.

The drug is usually prescribed to reduce cholesterol in the blood and prevent a first heart attack. However, a study of 4,159 men and women, 21 to 75 years old, who had already suffered their first heart attack, showed that pravastatin substantially reduces the risk of subsequent attacks, stroke, and death from heart disease in people without elevated cholesterol.

At levels of 240 milligrams per deciliter and above, cholesterol is considered a risk factor for heart disease, but the people in this five-year study had levels that averaged 209, about the average for the population of the U.S. and Canada. The majority of heart attack survivors also have levels below 240.

"From analysis of the data, we conclude that the importance of therapy with pravastatin can be extended to the majority of patients with coronary disease, including those at risk for stroke," said Eugene Braunwald, professor of medicine.

"The results are particularly compelling because patients enrolled in [the study] already were benefiting from optimal post-heart attack treatments such as aspirin, beta blockers," other drugs, and surgery, added Marc Pfeffer, associate professor of medicine.

Pravastatin, sold as Pravachol, thus becomes the first cholesterol-lowering drug to reduce the risk of stroke. Patients who received it in the study enjoyed a 31 percent reduction in the risk of stroke. These people also boasted a 24 percent drop in subsequent heart attacks and death from heart disease, and were less likely to undergo surgery, such as coronary bypass and angioplasty.

In today's issue of The New England Journal of Medicine, the medical team reports that, for every 1,000 heart-attack patients with cholesterol levels below 240, five years of treatment with pravastatin could prevent 150 cardiovascular events, ranging from fatal heart disease to a transient stroke or heart attack. Fifty-one patients would not have any such events.

If these people are over age 60, 207 instances of heart attack, stroke, and surgery would be prevented in men, 228 in women.

Another study, reported Tuesday by the American Heart Association, offers one possible reason for the significant reduction in risk and death. Researchers in the Netherlands found that pravastatin decreased temporary episodes of reduced blood flow through the arteries of the heart, in addition to lowering cholesterol.

They studied 768 male coronary patients who felt chest pain with physical exertion. After two years, 53 men treated with pravastatin experienced a cardiovascular event, compared to 75 men who took an inactive placebo.

Heart disease is the most common cause of death in the Western world; it claims more than 900,000 lives each year in the U.S. alone.