Statins should be used more widely in patients at risk for heart disease, based on results of HOPE-3 trial presented at the American College of Cardiology’s 65th Annual Scientific Sessions and published in the New England Journal of Medicine.
Conducted at 228 centers in 21 countries, the HOPE-3 trial assessed the use of cholesterol and blood pressure-lowering drugs in patients at risk for heart disease. To be eligible for the trial, participants had to be free of heart disease but have at least one risk cardiovascular risk factor like smoking or high blood sugar.
During the study, participants were randomized to receive either a cholesterol-lowering drug (rosuvastatin) or placebo plus blood pressure-lowering drugs (candesartan and hydrochlorothiazide) or placebo. Participants were at least 55 years old at the start of the study and followed for an average of 5.6 years.
As expected, researchers found that medications helped significantly lower cholesterol and blood pressure over the study period. For example, patients taking cholesterol-lowering drugs had 26.5% lower LDL or “bad” cholesterol than those taking the placebo. Patients taking blood pressure medications had significantly lower blood pressure than those who took the placebo pill. However, not all of these changes meant lower risk for heart events.
Overall, researchers found that cholesterol-lowering drugs were most effective in decreasing risk for heart events. Patients taking the cholesterol-lowering drug had 25% lower risk of heart events than those taking the placebo. Patients taking a combination of cholesterol-lowering drugs with blood pressure-lowering drugs also had significantly lower risk for serious heart events compared to placebo. However, blood pressure-lowering drugs did not appear to reduce future heart risks compared to the inactive placebo.
So what do findings mean? According to authors, findings support current recommendations for widespread statin use in adults at risk for heart disease. Current guidelines recommend adults between 40–75 years old with at least 7.5% risk for developing heart disease in the next ten years take statins to reduce cardiovascular risk. While recommendations faced plenty of criticism, findings provide clear evidence to support these guidelines.
However, many argue that additional research is needed when it comes to blood pressure-lowering drugs. It’s possible that with different medications, findings about their usefulness in reducing future heart risks may have been different. It’s also possible that patients need to be followed for longer periods of time to see meaningful benefits.
High blood pressure is a major risk factor for heart disease and heart attack, and blood pressure medication can be useful in reducing risk. With future studies, experts hope to better understand the impact of both statins and blood pressure-lowering drugs on the prevention of heart disease.