Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA):: a multicentre randomised controlled trial
Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA):: a multicentre randomised controlled trial
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DOI：
10.1016/s0140-6736(03)12948-0
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发表时间：
2003-04-05
期刊：
影响因子：
168.9
通讯作者：
Östergren, J
中科院分区：
文献类型：
--
作者：
Sever, PS;Dahlöf, B;Östergren, J
背景降低心血管疾病高风险个体的胆固醇浓度可以改善预后。然而，没有研究评估在常规认为不存在血脂异常的高血压患者中降低胆固醇在冠心病（CHD）一级预防中的益处。（年龄40-79岁，至少有三种其他心血管风险因素）在盎格鲁-斯堪的纳维亚心脏结局试验中随机接受两种抗高血压方案之一，10305例非空腹总胆固醇浓度≤ 6.5 mmol/L的受试者被随机分配额外的阿托伐他汀10 mg或安慰剂。这些患者组成了研究的降脂组。我们计划平均随访5年，主要终点为非致死性心肌梗死和致死性CHD。数据进行了分析，意向treat.Findings治疗后停止中位随访3.3年。到那时，阿托伐他汀组发生了100起主要事件，而安慰剂组发生了154起事件（风险比0.64 [95% CI 0.50-0.83]，p=0.0005）。这一好处出现在第一年的后续行动。在预先指定的亚组中没有显著异质性。致死性和非致死性卒中（89例阿托伐他汀vs 121例安慰剂，0.73 [0.56-0.96]，p=0.024），总心血管事件（389 vs 486，0.79 [0.69-0.90]，p=0.0005）和总冠状动脉事件（178 vs 247，0.71 [0.59-0.86]，p=0.0005）也显著降低。阿托伐他汀组有185例死亡，安慰剂组有212例死亡（0.87 [0.71-1.06]，p=0.16）。阿托伐他汀降低血清总胆固醇约1.3 mmol/L，与安慰剂相比，在12个月，和1.1 mmol/L后3 years of following.Interpretation的主要心血管事件与阿托伐他汀的减少是大的，考虑到随访时间短。这些发现可能对未来的降脂指南产生影响。
Background The lowering of cholesterol concentrations in individuals at high risk of cardiovascular disease improves outcome. No study, however, has assessed benefits of cholesterol lowering in the primary prevention of coronary heart disease (CHD) in hypertensive patients who are not conventionally deemed dyslipidaemic.Methods Of 19 342 hypertensive patients (aged 40-79 years with at least three other cardiovascular risk factors) randomised to one of two anti hypertensive regimens in the Anglo-Scandinavian Cardiac Outcomes Trial, 10305 with non-fasting total cholesterol concentrations 6.5 mmol/L or less were randomly assigned additional atorvastatin 10 mg or placebo. These patients formed the lipid-lowering arm of the study. We planned follow-up for an average of 5 years, the primary endpoint being non-fatal myocardial infarction and fatal CHD. Data were analysed by intention to treat.Findings Treatment was stopped after a median follow-up of 3.3 years. By that time, 100 primary events had occurred in the atorvastatin group compared with 154 events in the placebo group (hazard ratio 0.64 [95% CI 0.50-0.83], p=0.0005). This benefit emerged in the first year of follow-up. There was no significant heterogeneity among prespecified subgroups. Fatal and non-fatal stroke (89 atorvastatin vs 121 placebo, 0.73 [0.56-0.96], p=0.024), total cardiovascular events (389 vs 486, 0.79 [0.69-0.90], p=0.0005), and total coronary events (178 vs 247, 0.71 [0.59-0.86], p=0.0005) were also significantly lowered. There were 185 deaths in the atorvastatin group and 212 in the placebo group (0.87 [0.71-1.06], p=0.16). Atorvastatin lowered total serum cholesterol by about 1.3 mmol/L compared with placebo at 12 months, and by 1.1 mmol/L after 3 years of follow-up.Interpretation The reductions in major cardiovascular events with atorvastatin are large, given the short follow-up time. These findings may have implications for future lipid-lowering guidelines.