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Study supports broader use of statins in intermediate-risk populations

Lowering cholesterol with statins significantly reduced adverse cardiovascular events in people with average cholesterol and blood pressure levels who were considered to be at intermediate risk for heart disease, while the use of blood pressure-lowering medications was beneficial only in those with higher blood pressure levels, according to three separate reports from the large HOPE-3 trial presented at the American College of Cardiology’s 65th Annual Scientific Session.

Previous studies have focused on the impacts of cholesterol and blood pressure-lowering drugs for people with established cardiovascular or renal disease, diabetes, other high risk conditions or in those with markedly elevated cholesterol or blood pressure levels. Current guidelines recommend the use of these drugs mainly in patients at high risk for cardiovascular disease. The trial, called HOPE-3, is the first to assess outcomes of preventative treatment with cholesterol and blood pressure-lowering drugs in a large, globally diverse population at intermediate risk for developing cardiovascular disease. Statins – alone or in combination with blood pressure-lowering drugs – were found to be superior to placebo for both the study’s first co-primary endpoint, a composite of cardiovascular deaths, heart attacks and strokes, and its second co-primary endpoint, a composite of those events plus heart failure, resuscitated cardiac arrest and revascularization procedures, such as bypass surgery or angioplasty. For these endpoints, blood pressure drugs were found to improve outcomes compared with placebo only in patients with elevated blood pressure; these drugs were associated with no improvements in patients without elevated blood pressure, and there was a trend toward worse outcomes in those with relatively low blood pressure.

“The implications for practice are huge – I think we certainly should consider using statins much more widely than we have used them thus far,” said Salim Yusuf, M.B.B.S., D.Phil., professor of medicine at McMaster University, executive director of the Population Health Research Institute of McMaster University and Hamilton Health Sciences and a senior member of the research team. “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.”