Does Primary Prevention Benefit Patients at Intermediate CV Risk?

Results from the HOPE-3 trial, presented at the American College of Cardiology’s Annual Scientific Session and Expo held April 2-4, 2016, detailed the effectiveness of the use of statins and other antihypertensives on patients at intermediate risk for cardiovascular disease.

The 2-by-2 factorial trial randomly assigned 12,705 participants without cardiovascular disease but with at least 1 intermediate-risk criterion, including low high-density lipoprotein cholesterol levels, smoking, diet-controlled diabetes, or elevated waist-hip ratio to either daily rosuvastatin (10 mg) or placebo, plus daily candesartan/hydrochlorothiazide (16 mg/12.5 mg) or placebo. Baseline mean low-density lipoprotein cholesterol level was 128 mg/dL, and mean blood pressure was 138.1/81.9 mm Hg.
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Over 5.6 years of follow up, researchers conducted several analyses on the data collected. Findings from their analyses include the following:

  • Candesartan (16 mg) plus hydrochlorothiazide (12.5 mg) was not associated with a lower rate of major cardiovascular events than placebo.1
  • Rosuvastatin (10 mg) was associated with a significantly lower risk of cardiovascular events than placebo.2
  • Combining rosuvastatin (10 mg), candesartan (16 mg), and hydrochlorothiazide (12.5 mg) was associated with a significantly lower rate of cardiovascular events than dual placebo.3

The full findings from the trial were published in a series of articles in the New England Journal of Medicine.

—Michael Potts

References:

  1. Lonn EM, Bosch J, López-Jaramillo P, et al; HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease [published online April 2, 2016]. N Engl J Med. doi:10.1056/NEJMoa1600175.
  2. Yusuf S, Bosch J, Dagenais G, et al; HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease [published online April 2, 2016]. N Engl J Med. doi:10.1056/NEJMoa1600176.
  3. Yusuf S, Lonn E, Pais P, et al; HOPE-3 Investigators. Blood-pressure and cholesterol lowering in persons without cardiovascular disease [published online April 2, 2016]. N Engl J Med. doi:10.1056/NEJMoa1600177.