Risk of Heart Attack Significantly Reduced in About 90 days by Modern Combination of Drugs

Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)
2006-12-04 16:54 1147

-- 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


"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


"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


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


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

To view Figure 1 please register at PR Newswire for Journalists (PRNJ)

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).


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,

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


Bjorn Dahlof

Associate Professor

Department of Medicine

Sahlgrenska University Hospital/Ostra

University of Gothenburg, Sweden


Neil R Poulter

Professor of Preventive Cardiovascular Medicine

International Centre for Circulatory Health

National Heart and Lung Institute

Imperial College, London, UK


Hans Wedel

Professor of Epidemiology


Nordic School of Public Health

Gothenburg, Sweden


Source: Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)