Statins (a class of cholesterol-lowering drugs) are well known for their effectiveness in reducing cardiovascular risk. No study, however, has assessed the potential benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) among people with high blood pressure with normal or low cholesterol.
Around 10,000 people participating in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) who had average or below-average cholesterol (6.5 millimols per litre or less) were randomly allocated atorvastatin or placebo in addition to blood-pressure-lowering therapy. These patients were at moderately high risk of cardiovascular disease (having three or more risk factors in addition to high blood pressure), and were aged between 40 and 80 years (average age 63 years). Planned five-year follow-up assessed the primary endpoint of death from CHD and non-fatal heart attack.
Treatment was stopped after 3.3 years when it became clear that atorvastatin had benefits over placebo (100 primary events compared with 154, respectively-a relative risk reduction of 36%). Treatment with atorvastatin also reduced the risk of stroke and total cardiovascular events, with all benefits occurring in the first year of treatment.
Neil Poulter (one of the investigators) comments: "The reduction in major cardiovascular events with atorvastatin occurred earlier than in many other statin trials. These findings may have implications for future lipid-lowering guidelines."
In an accompanying Commentary, Lars Lindholm and Ola Samuelsson caution that the absolute risk reduction for patients given atorvastatin may not translate to substantial clinical benefit, especially when the cost of statin treatment is taken into account. Lars Lindholm concludes: "The difference between active treatment and placebo in the incidence of cardiovascular disease was only 3.4 per 1000 patient-years for the primary event and 2.0 per 1000 patient-years for stroke. Hence, active lipid-lowering treatment can be estimated to result in only a small increase in the probability of remaining free from a myocardial infarction over 5 years, from 95% to 97%, in patients with good control of blood pressure."
Contact: Tony Stephenson, Press Office, Imperial College, London SW7 2AZ, UK;
T) 44-207-594-6712;
F) 44-207-594-6700;
E) at.Stephenson@imperial.ac.uk
Professor Lars H Lindholm, Department of Public Health and Clinical Medicine, Umeå University, SE 901 85 Umeå, Sweden;
T) 46-907-853-526;
F) 46-907-76-883;
E) larsh.lindholm@fammed.umu.se
Note to Editors:
1 The study and Commentary will be published on THE LANCET's website (www.thelancet.com ) on Wednesday 2 April ahead of print publication in the April 5 issue of the print journal.
Journal
The Lancet