Taking cholesterol-lowering statins daily may prevent heart attacks and stroke in lower-risk patients, according to a major global study that could have a strong impact on future medical recommendations.
When patients with high blood pressure and moderate risk of heart disease took a blood pressure medication along with a statin, they reduced their long-term risk of heart disease by 40 percent, found the study published in the New England Journal of Medicine.
The data was presented on Saturday at the annual scientific sessions of the American College of Cardiology in Chicago.
The trial, called HOPE-3, spanned six continents, 21 countries and included nearly 13,000 men and women of various ethnic backgrounds who did not have heart disease. Most previous studies on heart disease prevention have been in white, North American patients with higher heart disease risk. About 80 percent of the HOPE-3 trial participants were not white.
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The trial included men who were 55 and older and women who were 65 and older with at least one cardiovascular risk factor, such as family history or obesity. On average, their cholesterol levels were about normal and systolic blood pressure was lower than 140 over 90.
Trial participants were randomly assigned placebos and low dosages of statins or antihypertensives (rosuvastatin — marketed as Crestor — and candesartan plus hydrochlorothiazide) for nearly six years. In that time, 3.7 percent of those who received 10 milligrams of the statin had heart attacks, strokes or cardiovascular-related deaths compared with 4.8 percent of those taking a placebo.
Statin-only patients were 24 percent less likely to experience fatal or nonfatal cardiovascular issues than those taking placebo. Those in the combined group showed slightly better benefits, which the researchers credit to the statin use.
The blood pressure drug alone had no better benefits than placebos at preventing heart disease, except in patients who had high blood pressure.
“The HOPE-3 trial provides evidence to reinforce some current guideline recommendations and to influence future guidelines,” reported the study authors.
The trial was funded by Canadian Institutes of Health and Research, and AstraZeneca, the pharma company that manufactures Crestor, which was used in the study. Included were research centers in China, India, Latin America, Africa and Canada (not the U.S. due to research costs).
Side effects of patients taking statins included muscle weakness and dizziness, which are known side effects of statin use. Statin patients also experienced slightly more cataract surgeries, but the researchers are unsure if this is just an association, not cause.
A recent JAMA study released Sunday at the American College of Cardiology in Chicago shows for the first time that statin intolerance is objectively identified in patients. The Cleveland Clinic researchers suggest that evolocumab (Repatha) is superior to ezetimibe (Zetia) for lowering cholesterol in statin-intolerant patients.
The researchers found that nearly 43 percent of patients who experienced muscle pain while taking at least two different statins had similar symptoms when given a statin during the study — yet, had no side effects when they were given a placebo. These patients reduced their LDL cholesterol levels by more than half when they were given a PCSK9 inhibitor, evolocumab, for 24 weeks, compared with a 17 percent reduction on ezetimibe.
Cardiovascular disease causes 18 million deaths globally each year and affects more than 1 billion adults worldwide, according to the American Heart Association.
Filed Under: Drug Discovery