Reports from the HOPE-3 trial showed that lowering cholesterol with statins significantly reduced adverse cardiovascular (CV) events in patients with average cholesterol and blood pressure levels at intermediate-risk for heart disease whereas the use of antihypertensives was helpful only for patients with higher blood pressure. The findings were presented at the American College of Cardiology’s 65th Annual Scientific Session.
Currently, guidelines recommend the use of cholesterol- and blood pressure-lowering agents primarily in patients at high risk for CV disease. The HOPE-3 trial (n=12,705) looked at outcomes of preventative treatment with these agents in a diverse cohort of patients at intermediate-risk for developing CV disease. Study patients had at least one known CV risk factor (eg, smoking, elevated waist-to-hip ratio, family history of heart disease) but no diagnosis of CV disease.
Patients were randomized to either rosuvastatin 10mg or a placebo daily with either candesartan/hydrochlorothiazide 16mg/12.5mg or placebo daily and categorized into 4 groups: cholesterol-lowering drug + blood pressure-lowering drug, cholesterol-lowering drug alone, blood pressure-lowering drug alone, and placebo alone. The follow-up period was a median of 5.6 years.
Statins, alone or in combination with antihypertensives, demonstrated superiority over placebo in the composite of CV deaths, heart attacks, and strokes (co-primary endpoint) and the composite of those events plus heart failure, resuscitated cardiac arrest and revascularization procedures (co-primary endpoint). CV death, heart attack, or stroke was seen in 3.5% of patients receiving both agents vs. 5% of patients receiving placebo. A relative risk reduction of 30% was seen overall in patients taking both drugs—40% in those with elevated blood pressure and 20% in those without elevated blood pressure. Researchers noted a trend toward worse outcomes in patients with relatively low blood pressure.
Results for the second co-primary endpoint were the same for this analysis. Salim Yusuf, MBBS, DPhil, a senior research member, added, “In particular for patients with hypertension, our study suggests you can essentially double the benefit of lowering blood pressure in hypertensives if you also lower cholesterol simultaneously.”
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