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Lipid lowering in hypertension and heart protection: observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Heart Protection Study

Journal of Human Hypertension volume 16, pages 815–817 (2002)Cite this article

Recent weeks have seen the early termination of the lipid arm of the Anglo Scandinavian Cardiac Out- comes Trial (ASCOT).1 The latter trial was designed with two main objectives: to compare the efficacy of ‘old’ antihypertensives (atenolol±diuretic) vs ‘new’ antihypertensives (amlodipine±perindopril), and to compare the effects of a statin (atorvastatin) with placebo in a subgroup of these hypertensives with total cholesterol below 6.5 mmol/l. The lipid arm was to investigate if a statin would confer additional protection against coronary heart disease (CHD) in hypertensive patients with total cholesterol levels that would ordinarily not be treated by physicians. The ‘high-risk’ hypertensive patients recruited into ASCOT were above the age of 40 years, with at least three other prespecified cardiovascular risk factors. By May 2000, 19 342 patients had been entered into the trial, out of which 10 297 patients were recruited into the lipid-lowering substudy. The mean total cholesterol in the lipid-lowering patients was 5.48±0.69 mmol/l.

The ASCOT Data Safety Monitoring Board found that within a period of 3 years, patients who were randomised to lipid lowering with atorvastatin had a significantly lower incidence of heart attacks and strokes compared to those who were on a placebo. The Data Safety Monitoring Board reported their findings to the ASCOT International Steering Committee on 2 September 2002, and the early termination of the cholesterol-lowering limb of the trial was recommended on 1 October 2002. It is too early to quantify the precise size of the effect, but a reduction in myocardial infarction by ‘about one-third’ among those taking atorvastatin is expected, as well as a reduction in strokes. Further announcements about the results of the atorvastatin part of the trial will be made in 2003, with final results of the whole ASCOT study expected in 2004. At the time of writing, the lipid-lowering arm of the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) still continues.

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  1. University Department of Medicine, City Hospital, Birmingham, UK

    S Nadar, H S Lim, D G Beevers & G Y H Lip

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  1. S Nadar
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Correspondence to G Y H Lip.

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Nadar, S., Lim, H., Beevers, D. et al. Lipid lowering in hypertension and heart protection: observations from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Heart Protection Study. J Hum Hypertens 16, 815–817 (2002). https://doi.org/10.1038/sj.jhh.1001512

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