Prevention of Cardiovascular Events and Death with Pravastatin in Patients with Coronary Heart Disease (LIPID Trial)

The LIPID trial (Long-Term Intervention with Pravastatin in Ischaemic Disease) randomized 9,014 patients with prior myocardial infarction or unstable angina across a wide range of baseline cholesterol levels to pravastatin 40 mg or placebo — deliberately enrolling patients with average and below-average cholesterol to test whether the statin benefit extended beyond the hypercholesterolemic range.

It did. Pravastatin reduced coronary heart disease mortality by 24 percent, all-cause mortality by 22 percent, and significantly lowered rates of MI, stroke, and coronary revascularization over six years. The benefit was consistent across baseline cholesterol levels, including patients whose cholesterol was not elevated by conventional standards.

LIPID was one of several foundational trials — alongside 4S, CARE, and WOSCOPS — that established the statin evidence base and drove the paradigm shift from cholesterol-threshold-based treatment to risk-based treatment. It demonstrated that absolute cardiovascular risk, not baseline cholesterol level, should determine who receives statin therapy in secondary prevention.

We rate the evidence strong. A cornerstone secondary prevention trial that contributed to the modern standard of universal statin therapy for patients with established coronary disease, regardless of baseline lipid levels.