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There is evidence that lipid lowering with atorvastatin significantly reduced the risk of major cardiovascular events in hypertensive patients with normal cholesterol levels in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
ASCOT - primary end point
End point | atorvastatin (%) | placebo (%) | hazard ratio | p |
MI/fatal CHD | 1.9 | 3.0 | 0.64 | 0.0005 |
ASCOT - secondary end points
End point | atorvastatin (%) | placebo (%) | hazard ratio | p |
Total CV events/procedures | 7.5 | 9.5 | 0.79 | 0.0005 |
Total coronary events | 3.4 | 4.8 | 0.71 | 0.0005 |
All-cause mortality | 3.6 | 4.1 | 0.87 | 0.16 |
CV mortality | 1.4 | 1.6 | 0.90 | 0.50 |
Fatal/nonfatal stroke | 1.7 | 2.4 | 0.73 | 0.02 |
Fatal/nonfatal CHF | 0.8 | 0.7 | 1.13 | 0.58 |
Drs Lars Lindholm and Ola Samuelsson in an accompanying Lancet commetary (2) note that while the ASCOT trial showed fairly large relative reductions in cardiovascular events associated with active lipid-lowering therapy, the absolute benefits are not so impressive. "In absolute terms 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 five years, from 95% to 97%, in patients with good control of blood pressure," they write. "The ASCOT investigators hope that their data will have implications for future lipid-lowering guidelines. However, any guideline changes should be left to the guidelines committees to decide, when they balance the limited absolute benefits against the treatment cost of lipid lowering," Drs Lindholm and Samuelsson conclude.
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