Trial finds statins, hypertensives do help prevent heart attacks, strokes

International researchers, along with experts from Australia, have tested whether three treatment options prevent heart attacks and strokes.

The team studied more than 12,000 people from 21 countries to evaluate drugs that can prevent cardiovascular diseases (CVD). They looked at treatments using cholesterol-lowering drugs called statins, a class of high-blood pressure drugs called anti-hypertensives, and a combination of both.

The three studies, named Heart Outcomes Prevention Evaluation-3 (HOPE-3), were published in the New England Journal of Medicine.

The trial included men 55 years of age or older and women 65 years of age or older who had at least one of the following cardiovascular risk factors: elevated waist-to-hip ratio; history of low concentration of high-density lipoprotein cholesterol; current or recent tobacco use; high blood glucose; family history of premature coronary disease; and mild renal dysfunction.

Professor Christopher Reid from Monash and Curtin universities, who led Australian investigators, along with John Varigos from Monash, said there was a 25–30 per cent reduction in events in the groups that received a statin alone or a statin with a blood pressure lowering medicine.

“There were also positive trends in those who received the blood pressure lowering treatment alone,” Reid said.

He added that treatment with a statin was remarkably safe and beneficial in the study, regardless of cholesterol or blood pressure levels, age, gender or ethnicity.

Heart Foundation National chief executive professor Garry Jennings said this is yet more evidence that statins are effective and well-tolerated treatments for people at risk of heart disease.
Jennings added the study illustrates the importance of Australian participation in global trials, as these results are likely to be adapted immediately to Australia.

“We estimate that 2.1 million Australians fulfil the present guidelines for treatment with statin as they are at high risk of having a heart event,” he said. “However, future guideline committees might consider expanding this eligibility to people at moderate risk of having a heart attack or stroke.”

He said the results support the foundation’s recommendations of treating a person based on their overall risk, rather than cholesterol or blood pressure in isolation.

One of the study leads, Dr Eva Lonn, professor of medicine at McMaster University, said the HOPE-3 trial brings clarity in the management of blood pressure and cholesterol, two of the most common cardiovascular risk factors.

“Primary prevention can be greatly simplified and made available to most intermediate-risk people worldwide,” Lonn said.

The research found:

• Statins proved to significantly and safely reduce CVD events by 25 per cent in patients at intermediate risk without CVD.
• Anti-hypertensives did not reduce major CVD events overall in the population studied, but did reduce such events in the group of people with hypertension, but not in those without hypertension.
• When combined, statins and anti-hypertensives reduced CVD events by 30 per cent, with a 40 per cent benefit in those with hypertension, suggesting that patients with hypertension should not only lower their BP but also consider taking a statin.

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