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The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure.
- Source :
-
European heart journal [Eur Heart J] 2008 Feb; Vol. 29 (4), pp. 499-508. Date of Electronic Publication: 2008 Jan 05. - Publication Year :
- 2008
-
Abstract
- Aims: To determine the cardiovascular benefits in those originally assigned atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-2.2 years after closure of the lipid-lowering arm of the trial (ASCOT-LLA).<br />Methods and Results: The Blood Pressure Lowering Arm of the ASCOT trial (ASCOT-BPLA) compared two different antihypertensive treatment strategies on cardiovascular outcomes. ASCOT-LLA was a double-blind placebo-controlled trial of atorvastatin in those enrolled into ASCOT-BPLA with total cholesterol concentrations at baseline of < or =6.5 mmol/L. A total of 19 342 hypertensive patients were enrolled in ASCOT-BPLA and 10 305 were further assigned either atorvastatin, 10 mg, or placebo. ASCOT-LLA was stopped prematurely after a median 3.3 years follow-up because of substantial cardiovascular benefits in those assigned atorvastatin. Trial physicians were invited to offer atorvastatin to all ASCOT-LLA patients until the end of ASCOT-BPLA. The primary outcome of ASCOT-LLA was combined fatal coronary heart disease (CHD) or non-fatal myocardial infarction. Secondary outcomes included all coronary events, all cardiovascular events and procedures, fatal and non-fatal stroke, cardiovascular mortality, all cause mortality, development of chronic stable angina, heart failure, and peripheral arterial disease. By the end of ASCOT-LLA, there was a 36% relative risk reduction in primary events (n = 254) in favour of atorvastatin [hazard ratio (HR) 0.64, 95% CI: 0.50-0.83, P = 0.0005]. At the end of ASCOT-BPLA, 2.2 years later, despite extensive crossovers from and to statin usage, the relative risk reduction in primary events (n = 412) among those originally assigned atorvastatin remained at 36% (HR 0.64, 95% CI: 0.53-0.78, P = 0.0001). For almost all other endpoints, risk reductions also remained essentially unchanged and in the case of all cause mortality, the risk reduction of 15% now achieved borderline statistical significance (P = 0.02).<br />Conclusion: Carry-over benefits from those originally assigned atorvastatin but no longer taking the drug may account for unchanged relative risk reductions in most cardiovascular endpoints observed 2 years after ASCOT-LLA closed.
- Subjects :
- Antihypertensive Agents therapeutic use
Atorvastatin
Coronary Disease mortality
Epidemiologic Methods
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
Hypertension drug therapy
Male
Middle Aged
Myocardial Infarction mortality
Stroke mortality
Stroke prevention & control
Anticholesteremic Agents therapeutic use
Coronary Disease prevention & control
Heptanoic Acids therapeutic use
Hypercholesterolemia prevention & control
Myocardial Infarction prevention & control
Pyrroles therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0195-668X
- Volume :
- 29
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- European heart journal
- Publication Type :
- Academic Journal
- Accession number :
- 18175773
- Full Text :
- https://doi.org/10.1093/eurheartj/ehm583