Pravastatin: an evidence-based statin?

Background: It is well known that statins lead to a markable reduction in cardiovascular morbidity and mortality. One of the first and best studied statins is pravastatin, which has been studied in both primary and secondary prevention trials. With 40 mg pravastatin daily, total cholesterol can be reduced by 25 - 34% with a very consistent risk reduction of 24% of death from cardiovascular diseases. Side effects are rare and usually consist of myopathy. Following the Adult Treatment Panel III (ATPIII) guidelines on cholesterol management, apart from therapeutic lifestyle changes, in high-risk patients (including patients with diabetes mellitus), cholesterol-lowering therapy should be targeted at a treatment goal of LDL cholesterol < 2.5 mmol/l. Statin-lowering therapy should be commenced to adequately lower cardiovascular risk. Therefore, when the expected 25 - 34% LDL cholesterol lowering would be enough to reach an LDL < 2.5 mmol/l, treatment should be started with pravastatin. Method: Trials have shown that treatment with pravastatin is safe in older patients as well as in children with familial hypercholesterolemia. Results/conclusion: Since obesity seems to become a worldwide problem and given the low costs of generic pravastatin, it may even be cost-effectively used in developing countries.