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Perhaps even
more intriguing, the magnitude of efficacy of statin therapy in the CARE trial was
directly related to the underlying level of inflammation present. When patients in the
CARE study were stratified by whether they had a heightened inflammatory response or a
lower inflammatory response, and then restratified according to placebo or pravastatin
allocation, the greatest effect for pravastatin was evident among those who had evidence
of inflammation. In fact, in these data, pravastatin appeared to greatly modify or
attenuate the inflammatory response. Even in the absence of inflammation, pravastatin
remained a highly effective clinical agent, indicating that in secondary prevention,
statin therapy should be given regardless of inflammatory response. Reference:
Ridker PM, Rifai N, Pfeffer MA, Sacks FM, Moye LA, Goldman S, Flaker GC, Braunwald E, for
the Cholesterol and Recurrent Events (CARE) Investigators. Inflammation, pravastatin, and
the risk of coronary events after myocardial infarction in patients with average
cholesterol levels. Circulation 1998;98:839-844.
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