Long-term cardiovascular benefits following statins and blood pressure trial

Researchers believe the earlier patients are prescribed treatments for lowering cholesterol and blood pressure the better

Death rates from heart disease and stroke could be significantly lowered by prescribing statins with blood pressure-lowering drugs, a study has found.

The findings come from long term follow up data from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and reveal that for patients with high blood pressure taking a calcium channel blocker-based treatment plus a statin, deaths from cardiovascular causes such as heart attack and stroke were lower than for those taking an alternative beta blocker-based treatment and who had not taken statins, more than a decade after the trial closed.

According to the researchers, the findings, published in The Lancet, further support the  evidence that treating hypertensive patients with cholesterol- and blood-pressure-lowering medications may have long term benefits for cardiovascular health, and that the earlier patients are prescribed the treatments the better.

The ASCOT trial was set up to compare two separate treatments for high blood pressure, but was stopped early as certain treatment combinations were so effective at preventing heart attacks and strokes. But according to the researchers, their new analyses have shown a legacy effect benefiting patients more than a decade later.

The authors highlight, however, that there is a period of more than 10 years following the end of the trial where they do not have full data available for treatments patients may have been taking or prescribed.

The latest findings, from researchers at Imperial College London and Queen Mary University of London, were presented at the European Society of Cardiology Congress in Munich today.

Blood pressure-lowering trial

In ASCOT, between 1998 and 2000, over 19,000 patients in the UK, Ireland and Scandinavia with high blood pressure were randomly allocated to one of two blood pressure lowering treatments – using a calcium channel blocker called amlodipine, plus perindopril, or a beta-blocker called atenolol, plus thiazide diuretic – (the blood pressure lowering arm, or BPLA*, of the trial). Half of all patients were then further randomised to receive the cholesterol-lowering statin atorvastatin or a placebo (the lipid lowering arm of the trial, or LLA**).

We have previously shown that statins can confer long term benefits on mortality after trials have stopped, but to our knowledge it has never before been shown that for patients with high blood pressure there may be long term benefits on preventing cardiovascular deaths Professor Peter Sever Study Author

In 2003, the lipid-lowering arm of the trial was stopped early after 3.3 years follow up,because the statin proved to be highly beneficial in preventing heart attacks and strokes. More than two years after the trial was stopped most participants from both groups were  taking statins. In 2005, the blood pressure-lowering  arm was stopped because the amlodipine arm prevented more strokes and deaths than the atenolol arm.

The new analysis looked at the number and cause of deaths among the 8,580 participants in the ASCOT trial who were based in the UK and followed up until December 2015

After 16 years’ follow-up, a total of 3,282 patients had died. Of those originally treated with atorvastatin (and who would have received statins for at least two years more than the placebo group) there were 15 per cent fewer cardiovascular deaths compared with those originally assigned to the placebo arm of the trial.

For those originally treated with amlodipine, compared with atenolol, there were 19 per cent fewer deaths from stoke.

The data also show there were 10 per cent overall fewer cardiovascular deaths, although the latter was not found to be statistically significant.

Long-term benefits

Professor Peter Sever, from the National Heart and Lung Institute at Imperial College London, who led the study together with Dr Ajay Gupta from Queen Mary University of London, said: “We have previously shown that statins can confer long term benefits on mortality after trials have stopped, but to our knowledge it has never before been shown that for patients with high blood pressure there may be long term benefits on preventing cardiovascular deaths – particularly strokes in patients treated with a calcium channel blocker-based regimen.”

Professor Sever added: “We are continuing to research the underlying mechanisms that explain these findings, which have important implications for today’s treatment of hypertension and raised cholesterol.”

The initial results of ASCOT influenced national and international guidelines for blood pressure treatment and lipid-lowering for people at risk of heart disease and stroke, including those produced by NICE in the UK.

The study was investigator lead with funding provided by Pfizer. Professor Sever is a National Institute for Health Research Senior Investigator and the researcher was supported by the  Biomedical Research Centre Award to Imperial College Healthcare NHS Trust, from the National Institute for Health Research.

-

‘Long-term mortality after the blood pressure and lipid-lowering treatment in hypertensive patients: 16-year follow-up of the Anglo-Scandinavian Cardiovascular Outcomes Trial (ASCOT) Legacy study’ by Ajay Gupta et al. is published in The Lancet.

See the press release of this article