The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial Lipid Lowering Trial (ALLHAT-LLT),1 published
in this issue of THE JOURNAL, is the second-largest lipid-lowering trial yet
reported. This randomized trial, a subset of the larger ALLHAT hypertension
study,2 followed up 10 355 patients (49%
women) who had hypertension and were 55 years or older for a mean of 4.8 years.
Patients were randomly assigned to receive 40 mg of pravastatin (open label)
vs "usual care" in 513 clinical centers, the majority of which were community-based.
These centers were a subset of the 623 centers that treated patients for the
larger (N = 33 357) ALLHAT hypertension study.2 Despite
a 28% reduction in low-density lipoprotein cholesterol (LDL-C) from baseline
in the pravastatin treatment group, the trial failed to show a benefit in
either the primary outcome (all-cause mortality) or the key secondary outcome
(combined nonfatal myocardial infarction and fatal coronary heart disease).1 How can this be? Why didn't ALLHAT-LLT work?
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