By studying the effects of rosuvastatin (10 mg/day) on LDL-C, researchers found that the agent resulted in a significantly lower risk of CV events. The first coprimary outcome occurred in 235 patients (3.7%) of the treatment group and 304 patients (4.8%) in the placebo group (hazard ratio: 0.76; 95% confidence interval: 0.64-0.91; P=.002). Interestingly, results were consistent regardless of race or ethnic group, lipid level, C-reactive protein level, BP, or CV risk at baseline.

Dr Salim Yusuf, president of the World Heart Federation, was careful to note that trials lasting 5 to 6 years, such as HOPE-3, often underestimate the benefits of prevention. Over longer periods of time, combining treatments will lead to better risk reduction and more cost-effective healthcare. “If you don’t have to bring [patients] back to re-titrate drugs over and over again, you’re saving money,” Dr Yusuf said. “You’re also saving [the patient] in indirect ways—time, travel, etc.” 


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He urged, “We have to simplify prevention. Otherwise, it will not be used widely.”

Valentin Fuster, MD, editor-in-chief of the Journal of the American College of Cardiology, echoed that sentiment. “The future of prevention is no doubt in simplicity,” he remarked at the ACC press conference. “It’s fascinating that you [HOPE-3 investigators] designed such a complex trial to reach simplicity.”  

Dr Yusuf added that although this was the first formal testing of a polypill concept on clinical events, more trials are needed to study the intermediate-risk patient population.

While the HOPE-3 findings may appear to encourage a “one-size fits all” approach to antihypertensive and lipid-lowering therapy, all 3 investigators insisted that individualized care is paramount.

“Our findings contradict the ‘lower is better’ hypothesis that has been derived from epidemiologic studies and our findings support the concept that a J-curve phenomenon exists for major CV events, other than for stroke, in this population,” the researchers concluded in 1 of their 3 published reports. “…Our data are compatible with the hypothesis that treating persons without CVD who have a SBP above approximately 140 mm Hg appears to be beneficial, but treatment would not be of benefit and may be even harmful in persons with lower SBP levels.”

References

  1. Bosch J, HOPE-3 Investigators. Abstract 401-18. Effects of rosuvastatin on cardiovascular disease in moderate risk primary prevention in diverse ethnic groups. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL.
  2. Lonn EM, Bosch J, Lopez-Jaramillo P, et al; for the HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016. doi: 10.1056/NEJMoa1600175.
  3. Lonn EM, HOPE-3 Investigators. Abstract 401-17. Blood pressure lowering in people at moderate risk. The HOPE-3 trial. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL.
  4. Yusuf S, Bosch J, Dagenais G, et al; for the HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. doi: 10.1056/NEJMoa1600176.
  5. Yusuf S, HOPE-3 Investigators. Abstract 401-19. Effects of combined lipid and BP-lowering on cardiovascular disease in a moderate risk global primary prevention population. Presented at the 65th Annual Scientific Session and Expo of the American College of Cardiology. April 2-4, 2016; Chicago, IL.
  6. Yusuf S, Lonn E, Pais P, et al; for the HOPE-3 Investigators. Blood-pressure and cholesterol lowering in people without cardiovascular disease. N Engl J Med. doi: 10.1056/NEJMoa1600177.

This article originally appeared on The Cardiology Advisor