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The Lancet, Volume 361, Issue 9355, Pages 427 - 428, 1 February 2003 < Previous Article | Next Article > Article Options
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The PROSPER trial
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The increased incidence of diagnosed cancers in the PROSPER trial1 is disturbing, biologically plausible, significant, and shouldnot be attributed to a chance finding.
Other Articles of Interest
Articles Pravastatin in elderly
Cancer incidence over the 3·2 years of the trial was 6·8% in the placebo group and 8·5% in those randomised to pravastatin individuals at risk of vascular
(p=0·020). Cancer death during the trial was 3·1% in the placebo group and 4·0% in the pravastatin group. This exactly disease (PROSPER): a
randomised controlled trial

cancelled the mortality benefit of coronary heart disease death, which was 4·2% in the placebo group and 3·3% in thepravastatin group. All-cause death was unchanged, implying that pravastatin treatment changed how a patient died by Review Stroke prevention,
increasing cancer death and decreasing death from coronary heart disease.
blood cholesterol, and statins
Pravastatin decreases natural killer cell cytotoxicity.2 Low cytotoxic activity of natural killer cells is associated with Commentary High-risk elderly
patients PROSPER from

increased cancer risk.3 Elderly people can be particularly susceptible to the untoward effects of decreasing immune function.
cholesterol-lowering therapy
Review Lipid management in
There are reasons why other 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) did not show an increased the prevention of stroke:
cancer incidence in other trials. The PROSPER trial was unique since the average age of patients at trial entry was 75 years, review and updated
which is substantially more than that of previous statin trials. In subgroup analysis of the Heart Protection Study,4 there was meta-analysis of statins for
no excess cancer in older patients randomised to sim-vastatin over the 5-year trial. However, individual statins have differing stroke prevention
pharmacokinetic properties.5 Therefore, comparison of the PROSPER trial with other statin trials is difficult.
Articles Primary prevention of
cardiovascular disease with
pravastatin in Japan (MEGA

I feel that pravastatin should be used cautiously in the elderly because it could increase cancer incidence. Long-term Study): a prospective
follow-up of PROSPER and other statin trials should help resolve this important issue.
randomised controlled trial
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1 Shepherd J, Blauw GJ, Murphy MB, et alon behalf of the PROSPER study group. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623-1630. Summary | Full Text | PDF(113KB) |
2 Kobashigawa JA, Katznelson S, Laks H, et al. Effect of pravastatin on outcomes after cardiac transplantation. N Engl J Med StumbleUpon
1995; 333: 621-627. CrossRef | PubMed
3 Imai K, Matsuyama S, Miyake S, Suga K, Nakachi K. Natural cytoxic activity of peripheral-blood lymphocytes and cancer
incidence: an 11-year follow-up study of a general population. Lancet 2000; 356: 1795-1799. Summary | Full Text | PDF(85KB)
| CrossRef | PubMed
4 Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in
20 536 high-risk individuals: a randomised placebo-controlled trial. Lancet 2002; 360: 7-22. Summary | Full Text | PDF(207KB)
| CrossRef | PubMed
5 Chong PH, Seeger JD, Franklin C. Clinically relevant differences between the statins: implications for therapeutic selection.
Am J Med 2001; 111: 390-400. CrossRef | PubMed
a Cleveland Clinic Florida, Naples, FL 34119, USA
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