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“It’s very important to manage risk factors, including hypercholesterolemia, in black patients at risk for cardiovascular disease,” lead author Dr. Karen L. Margolis, from the University of Minnesota Medical School, Minneapolis, told Reuters Health. “Although things are improving, there are still disparities in treatment, and black patients receive less treatment for hypercholesterolemia than white patients. Our results show that there is no reason to doubt that black patients will benefit from statin treatment.”

Dr. Margolis and colleagues in the ALLHAT Collaborative Research Group analyzed the composite endpoint of nonfatal MI and fatal coronary heart disease in four groups: 1991 black patients randomized to pravastatin, 1920 blacks assigned to usual care, 3179 non-blacks randomized to pravastatin, and 3265 non-blacks assigned to usual care. Both pravastatin groups took 40 mg/day.

Visit attendance and medication adherence did not differ significantly between blacks and non-blacks in the pravastatin and usual care groups, the authors report.

At 2 years, pravastatin had decreased total cholesterol levels by 34 mg/dl in blacks and 35 mg/dL in non-blacks. In the usual care groups, cholesterol fell by 9 mg/dL and 10 mg/dL in blacks and non-blacks, respectively.

By year 6, total cholesterol decreases were again similar for blacks (44 mg/dL) and non-blacks (47 mg/dL) in the pravastatin groups and for blacks (22 mg/dL) and non-blacks (29 mg/dL) in the usual care groups.

In all races, independent predictors of coronary heart disease included age, male sex, a previous history of coronary heart disease, and diabetes.

However, only in blacks was pravastatin treatment associated with a lower risk of coronary heart disease, the investigators say. This association persisted after adjustment for changes in total cholesterol, systolic blood pressure, and diastolic blood pressure during follow-up. The adjusted hazard ratios for coronary heart disease with pravastatin treatment were 0.65 in blacks versus 1.07 in non-blacks.

There are “two possibilities for why we saw differences between blacks and non-blacks,” Dr. Margolis said. “It could be that for a given degree of cholesterol lowering, blacks actually experience greater protection against coronary heart disease from statins than non-blacks.”

“The other possibility is that chance could account for our results, but I don’t think that’s the case,” Dr. Margolis said. “We are in the process of examining long-term follow-up of the ALLHAT-LLT cohort, and we’ll be looking at whether a differential in coronary heart disease incidence in blacks remains after an extended follow-up period.”

Reference:
Am Heart J 2009;158:948-955.

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