Coronary heart disease benefits from blood pressure and lipid-lowering
Sever PS et al. – Coronary heart disease (CHD) benefits associated with blood pressure (BP) and lipid lowering were larger than predicted by previous observational and trial data. Compared with pre-trial treatment, treating an estimated 55 pts with the amlodipine-based regimen and atorvastatin would prevent 1 CHD event per year. Methods- Report of analyses on combined benefits of atorvastatin and an amlodipine-based regimen for CHD events in hypertensive pts in Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)
- Randomization of 19,342 hypertensive pts to either an amlodipine or atenolol-based regimen in ASCOT Blood Pressure-Lowering Arm (BPLA)
- Further randomization 10,305 subjects with total cholesterol ≤6.5 mmol/L to atorvastatin 10 mg or placebo in Lipid-Lowering Arm (LLA)
- Estimates of CHD risk at baseline based on Framingham algorithm compared with observed and predicted event rates throughout ASCOT-LLA
Results- Estimated baseline Framingham risk of CHD events: 22.8 / 1000 pt yrs
- After 3.3 yrs, when LLA stopped, actual CHD event rate was 4.8 / 1000 pt years -- 79% reduction in pts assigned amlodipine-based treatment and atorvastatin
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