Which treatments work best for preventing cardiovascular events?
Researchers from the William Harvey Research Institute at Queen Mary University London in the United Kingdom have recently made public the results of a large long-term study that looked at the efficiency of different treatments in keeping cardiovascular disease at bay.
A combination of blood pressure-lowering drugs and statins (which are drugs that help regulate cholesterol levels) show the best results, the experts explain.
"Patients in their mid-60s with high blood pressure were less likely to die from heart disease or stroke by age 75–80 if they had taken both calcium channel blocker-based blood pressure lowering treatment and a statin," explains Dr. Ajay Gupta.
Best preventive approach against stroke?
The scientists derived their results from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study, which continued the work started by the original ASCOT.
In the new study, the investigators followed 8,580 U.K. participants who were initially recruited in 1998–2000. All of the participants had high blood pressure at baseline, as well as several risk factors for developing cardiovascular disease.
The original ASCOT study had three main aims; first, to test which of two approaches to treatment — a traditional or an innovative one — would work best for preventing heart attacks.
To do so, the team gave some participants the innovative therapy, which consisted of amlodipine and, if necessary, perindopril. These are two specialized drugs that aim to lower blood pressure.
The other participants all took the traditional treatment of atenolol (another blood pressure drug), and bendroflumethiazide (which is a diuretic used to treat hypertension), to which potassium was added on a case-by-case basis.
Since the novel approach proved effective in preventing strokes and premature death after a median period of 5.5. years, the researchers stopped the trial at that point.
The ASCOT study's second aim was to see whether people with high blood pressure who also took statins would be any more shielded against the development of coronary heart disease. The team gave this new treatment to those with hypertension and average cholesterol levels (under 6.5 millimoles per liter).
On the basis of a randomized allocation, these participants took either atorvastatin or a placebo for 3.3 years. Once more, the trial was so successful in preventing heart attacks and strokes that it ended early.
Finally, the ASCOT study also aimed to assess the overall effectiveness of the two therapies for blood pressure in individuals with hypertension and high cholesterol (reading over 6.5 millimoles per liter).
The researchers did not give statins to this group of participants over the 5.5 years during which they were involved in the study.
'These results are remarkable'
Based on the ASCOT data, Dr. Gupta and team were able to assess the effectiveness of the various treatment combinations in the long-term.
They found that the study participants who had taken amlodipine and perindopril for 5.5 years had a 29 percent lower likelihood of having died due to a stroke 10 years later, compared with the participants who followed the traditional therapy for blood pressure.
Moreover, participants with average cholesterol levels at baseline who took a statin during the trial had a 15 percent lower risk of death due to heart disease and stroke after 16 years, compared with those who only took a placebo.
Also, the participants with high cholesterol at baseline who took their usual cholesterol-lowering treatment as well as the innovative blood pressure therapy saw 21 percent fewer deaths due to cardiovascular disease over 10 years.
"These results are remarkable. We have previously shown that statins confer long-term survival benefits after trials have stopped, but this is the first time it has been found with a blood pressure treatment."
Study co-author Prof. Peter Sever
Prof. Mark Caulfield, the director of the William Harvey Research Institute, also emphasizes the importance of the study's findings for preventive medicine.
"This study confirms the importance of lowering blood pressure and cholesterol to prevent disabling and life-shortening cardiovascular disease," he notes.