-- New Results From the Only Large European Study Combining Blood
Pressure-Lowering With Cholesterol Reduction in Patients With
Moderate Cardiac Risk Prevents Half of Heart Attacks
LONDON, Dec. 4 /Xinhua-PRNewswire/ -- The risk of heart attack can be
reduced by more than 50 percent by combining a cholesterol-reducing drug,
atorvastatin calcium, with a blood pressure-lowering drug, amlodipine
besylate, and the benefits are evident for heart attacks as early as 90 days
after the start of treatment.
Additionally, in the trial, the simultaneous initiation of atorvastatin
and amlodipine treatment was about three times more effective at preventing
heart attacks than adding atorvastatin, a statin, to one of the world’s most
widely used blood pressure-lowering drugs, atenolol, a beta-blocker.
For the first time, results from a large trial -- the Anglo-Scandinavian
Cardiac Outcomes Trial (ASCOT), which recruited >19,000 patients in the UK,
Ireland and the Nordic countries -- show that the addition of atorvastatin to
amlodipine (a calcium channel blocker) reduced the risk of fatal and non-
fatal cardiac events by 53%, and clinical benefits were evident after only
three months’ treatment (p=0.02). This contrasted with the addition of
atorvastatin to atenolol, which only achieved a non-significant 16% reduction
by the end of the study (median 3.3 years), according to a paper published on-
line in the European Heart Journal today. (See Figure 1)
According to a principal ASCOT investigator, Professor Peter Sever of the
International Centre for Circulatory Health, Imperial College, London, UK,
these results have major implications for physicians and their patients
worldwide.
"ASCOT demonstrates that the risk of heart attacks can be more than
halved in the many patients at moderate risk who doctors see every day. In
addition, there is a reduction in strokes of >25 percent. This is achieved by
combining two well-known and widely-used drugs -- amlodipine and
atorvastatin.
"However, if we continue to use older blood pressure-lowering drugs, such
as atenolol, and choose only to treat high blood pressure in isolation
without giving a statin, we only confer a small part of this potential
benefit. As a result, the risk of heart attacks and strokes remains
unacceptably high in too many patients despite treatment to blood pressure
targets," Professor Sever said.
Results establish important hypothesis for future research
The differences in risk reduction between the two treatments may be
explained by recent and ongoing laboratory studies. Earlier laboratory
research and clinical studies suggest that amlodipine and atorvastatin may
stabilize the fatty deposits in the walls of the arteries (atherosclerotic
plaques) which can rupture to cause cardiovascular events such as heart
attacks.
Professor Sever said: "The new data generate an important hypothesis that
suggests a synergistic effect between atorvastatin calcium and amlodipine
besylate, which goes beyond the effects of the individual drugs. This is an
exciting possibility for future research, which we and other groups will be
exploring."
The future of treatment
The ASCOT Study is resulting in a re-evaluation of the management of
patients with a moderately increased risk of cardiac events worldwide. The
importance of combining a contemporary blood pressure drug regimen based on a
calcium channel blocker with a statin is gaining importance. Meanwhile, the
use of beta-blockers -- except where they are specifically indicated -- is
being questioned.
"For the first time, these important data show that the selection of a
blood pressure-lowering drug regimen combined with a statin may have
significant clinical implications for preventing heart attacks. It is vital
that we use the right combination from the start to maximize the reduction in
cardiac risk," Professor Sever said.
Note to Editors
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http://www.prnewswire.com/media
About cardiovascular risk
More that 330 million adults in Europe and North America suffer from high
blood pressure, which also affects an additional 639 million men and women in
the rest of the world. (The Lancet, January 2005)
About 80% of people with high blood pressure have additional uncontrolled
cardiovascular risks. (World Health Organisation).
About ASCOT
ASCOT is the largest European study of people with high blood pressure
and > 3 additional common cardiac risk factors, e.g. history of smoking, age
> 55 years, diabetes, lipid abnormalities, etc. It included more than 19,000
men and women with high blood pressure who were at a moderate risk of strokes
and heart attacks and without previous history of heart disease. To control
their blood pressure, they received either the newer drug -- a calcium
channel blocker, amlodipine besylate -- or a beta-blocker, atenolol, to which
the ACE inhibitor perindopril or the diuretic bendroflumethiazide were added,
respectively, if necessary, to control the BP. Additionally, 10,000 patients
also were treated with the cholesterol-lowering drug atorvastatin calcium or
a placebo (dummy pill). This is the only major European study to date to
combine these two treatment strategies.
The most commonly seen adverse events (AEs) in the amlodipine regimen
were peripheral oedema and cough. The most commonly seen AEs in the atenolol
regimen were dizziness and fatigue. No new, unexpected AEs were observed
beyond those seen in previously published ASCOT results. Further details can
be found at the ASCOT Web site, http://www.ascotstudy.org
Potential synergy between lipid-lowering and blood pressure-lowering in
the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm
Peter Sever, Bjorn Dahlof, Neil Poulter, Hans Wedel, Gareth Beevers, Mark
Caulfield, Rory Collins, Sverre Kjeldsen, Arni Kristinsson, Gordon McInnes,
Jesper Mehlsen, Markku Nieminem, Eoin O’Brien and Jan Ostergren
European Heart Journal 2006, Volume 27; 24: 2982-2988
Executive Committee of the ASCOT Trial
Peter S Sever
Professor of Clinical Pharmacology & Therapeutics
International Centre for Circulatory Health
National Heart and Lung Institute
Imperial College, London
& St Mary’s Hospital, London, UK
Email: p.sever@imperial.ac.uk
Bjorn Dahlof
Associate Professor
Department of Medicine
Sahlgrenska University Hospital/Ostra
University of Gothenburg, Sweden
Email: bjorn.dahlof@scri.se
Neil R Poulter
Professor of Preventive Cardiovascular Medicine
International Centre for Circulatory Health
National Heart and Lung Institute
Imperial College, London, UK
Email: n.poulter@imperial.ac.uk
Hans Wedel
Professor of Epidemiology
Biostatistics
Nordic School of Public Health
Gothenburg, Sweden
Email: hans.wedel@biostat.se