Statin response enhanced in Black CHD patients
MedWire News: Researchers have confirmed a significant reduction in coronary events among Black patients who received pravastatin in ALLHAT-LLT, despite the overall negative results of the study.
The apparent lack of effectiveness of pravastatin in coronary heart disease (CHD) patients in ALLHAT-LLT (Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial–Lipid-Lowering Trial) has been attributed to a smaller than expected difference in lipid levels between the statin and usual care groups. This may have been due to nearly 20% of the usual-care patients receiving open-label statin therapy during the trial.
But the data also indicated a race–treatment interaction. ALLHAT included 3911 Black patients, comprising 38% of participants – notably more than in other statin trials.
Researchers led by Karen Margolis (Health Partners Research Foundation, Minneapolis, Minnesota, USA) conducted a prespecified analysis of the ALLHAT-LLT participants stratified by race.
They report that Black patients randomly assigned to pravastatin 40 mg/day had a significant 29% reduction in the risk for nonfatal myocardial infarction and fatal CHD relative to Black patients assigned to usual care.
This risk reduction was independent of baseline characteristics including age, gender, aspirin use, history of CHD and diabetes, body mass index, and smoking status. It persisted after further adjustment for blood pressure and lipid levels achieved during ALLHAT.
In contrast, pravastatin did not affect CHD outcomes in the 6444 non-Black patients.
Margolis and team note that their subgroup findings could be down to chance, and require corroboration. But they also say that GenHAT, the genetic ancillary study to ALLHAT, implicates genetic differences as a possible mechanism underlying racial differences in the response to pravastatin.
“Although the proportion of Blacks who are being treated for hypercholesterolemia according to current guidelines is improving, racial disparities in treatment and cholesterol lowering remain,” the researchers comment in the American Heart Journal.
They add: “These findings… lend further support for the need to intensify efforts to eliminate these disparities.”
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By Eleanor McDermid