Evidence map›Statins × cardiovascular events›PMID 9843456›Full record

Trial reportCirculation1998

Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators.

R B Goldberg, M J Mellies, F M Sacks, L A Moyé, B V Howard, W J Howard, B R Davis, T G Cole, M A Pfeffer, E Braunwald

Open access · bronzeAbstract readClinical TrialRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Circulation, 1998. The graph read 1 number from its abstract, feeding 1 cell of the map: it . Cited by 156 papers, 14 of them syntheses that pooled it.

1number the graph read from it
1cell of the map it votes in
156citing papers in PubMed, 14 pooled it
60.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
-32.00 · no effect
Cardiovascular eventsfavours the treatment · head-to-head · dyslipidemia, t2dfeeds one cell of the map
reduced -32.0P=0.04
Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients.
FeedsStatins×cardiovascular events

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×cardiovascular events

No readable resultOpen on the map →What to test next →

29 readable studies in this cell: 18 favour the treatment, 10 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
0 · no effect
This paper · 1998
reduced -32.0
NCT002899002,340 enrolled · 2006
Δ -0.10-0.40 to 0.60
NCT01294683977 enrolled · 2011
Δ 0.00-0.97 to 0.97
NCT00728988499 enrolled · 2008
Δ 1.00-7.30 to 9.30
Pravastatin and cardiovascular risk in moderate chronic kidney disease…PMID 19423108 · 2009
RR 55.0
Effect of pravastatin on cardiovascular events in older patients with …PMID 9841599 · 1998
absolute reduction -2.90-4.50 to -0.30
Reduced coronary events in simvastatin-treated patients with coronary …PMID 10597756
RR 0.58
Prevention of cardiovascular events and death with pravastatin in pati…PMID 9841303 · 1998
reduction -29.0
Primary prevention of cardiovascular disease with atorvastatin in type…PMID 15325833
reduction -37.0-52.0 to -17.0
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

156 citing papers in PubMed, 14 syntheses or guidelines pooled it, 991 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline.The Journal of clinical endocrinology and metabolism · 2019
    Guideline
  5. Pooled it
  6. Guideline
  7. Pooled it
  8. Guideline
  9. Guideline
  10. Standards of medical care in diabetes--2010.Diabetes care · 2010 · on this map
    Guideline
  11. Pooled it
  12. Pooled it
  13. Guideline
  14. Pooled it
  15. Trial
  16. Factors Influencing Physician Counseling on Cardiovascular Risk.Journal of primary care & community health · 2016
    Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

96 more citing papers are in PubMed but not listed here.

6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

R B GoldbergUniversity of Miami School of Medicine, Miami, FL, USA.
M J Mellies
F M Sacks
L A Moyé
B V Howard
W J Howard
B R Davis
T G Cole
M A Pfeffer
E Braunwald
Bristol-Myers Squibb (United States) · USWashington University in St. Louis · USUniversity of Miami · USMedStar Washington Hospital Center · US

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundAlthough diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels. METHODS AND

resultsThe Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes--136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides--were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P=0.05) and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50%, P=0.05 for nonfatal MI).

conclusionsDiabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.

Indexed as

Diabetes ComplicationsAdultAgedAnticholesteremic AgentsCholesterolDiabetes MellitusFemaleGlucose IntoleranceHumansMaleMiddle AgedMyocardial InfarctionPravastatinRiskAnticholesteremic AgentsCholesterolPravastatin

Identifiers

PMID9843456
OpenAlexW2115728877

What OpenQuestion holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.