Skip Navigation


European Heart Journal Advance Access originally published online on December 4, 2006
European Heart Journal 2006 27(24):2982-2988; doi:10.1093/eurheartj/ehl403
This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow A corrigendum has been published
Right arrow All Versions of this Article:
27/24/2982    most recent
ehl403v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (35)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Sever, P.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Sever, P.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial

Peter Sever, Björn Dahlöf, Neil Poulter, Hans Wedel, Gareth Beevers, Mark Caulfield, Rory Collins, Sverre Kjeldsen, Arni Kristinsson, Gordon McInnes, Jesper Mehlsen, Markku Nieminem, Eoin O'Brien, Jan Östergren on behalf of the ASCOT Steering Committee Members

Clinical Pharmacology and Therapeutics, Imperial College London, International Centre for Circulatory Health, 59 North Wharf Road, London W2 1PG, UK

Received 30 May 2006; revised 5 October 2006; accepted 7 November 2006; online publish-ahead-of-print 4 December 2006.

Corresponding author. Tel: +44 0 207 594 1100; fax:+44 0 207 594 1145. E-mail address: p.sever{at}imperial.ac.uk

Aims A prespecified objective of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) was to assess whether any synergistic effects were apparent between the lipid-lowering and blood-pressure-lowering regimens in preventing cardiovascular events.

Methods and results A total of 19 257 hypertensive subjects were randomized to an amlodipine-based regimen or an atenolol-based regimen. Of these, 10 305 subjects with total cholesterol ≤6.5 mmol/L were further randomized to atorvastatin 10 mg daily or placebo. In this analysis, the effects of atorvastatin were compared with placebo on coronary heart disease (CHD), cardiovascular and stroke events in those assigned amlodipine-based and atenolol-based regimens. In the ASCOT lipid-lowering arm (LLA), overall, atorvastatin reduced the relative risk of the primary endpoint of non-fatal myocardial infarction and fatal CHD events by 36% (HR 0.64, CI 0.50-0.83, P=0.0005), total cardiovascular events by 21% (HR 0.79, CI 0.69–0.90, P=0.0005), and stroke by 27% (HR 0.73, CI 0.56–0.96, P=0.024). However, atorvastatin reduced the relative risk of CHD events by 53% (HR 0.47, CI 0.32–0.69, P<0.0001) among those allocated the amlodipine-based regimen, and by 16% (HR 0.84, CI 0.60–1.17, p: n.s.) among those allocated the atenolol-based regimen (P=0.025 for heterogeneity). There were no significant differences between the effects of atorvastatin on total cardiovascular events or strokes among those assigned amlodipine (HR 0.73, CI 0.60–0.88, P<0.005 and HR 0.69, CI 0.45–1.06, P: n.s., respectively) or atenolol (HR 0.85, CI 0.71–1.02, P: n.s and HR 0.76, CI 0.53–1.08, P: n.s, respectively). Differences in blood pressure and lipid parameters (placebo corrected) between the two antihypertensive treatment limbs could not account for the differences observed in CHD outcome.

Conclusion These findings of an apparent interaction between atorvastatin and an amlodipine-based regimen in the prevention of CHD events are of borderline significance, and hence generate an hypothesis that merits independent evaluation in other trials.

Key Words: Coronary heart disease • Morbidity • Mortality • Atorvastatin • Blood pressure lowering • Amlodipine • Perindopril • Atenolol • Thiazide • Synergy


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 StrokeHome page
P. Amarenco, L. B. Goldstein, M. Messig, B. J. O'Neill, A. Callahan III, H. Sillesen, M. G. Hennerici, J. A. Zivin, K.M.A. Welch, and on behalf of the SPARCL Investigators
Relative and Cumulative Effects of Lipid and Blood Pressure Control in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial
Stroke, July 1, 2009; 40(7): 2486 - 2492.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
B. Williams, P. S. Lacy, J. K. Cruickshank, D. Collier, A. D. Hughes, A. Stanton, S. Thom, H. Thurston, and for the CAFE and ASCOT Investigators
Impact of Statin Therapy on Central Aortic Pressures and Hemodynamics: Principal Results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study
Circulation, January 6, 2009; 119(1): 53 - 61.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
E. D. Peterson and T. Y. Wang
The Great Debate of 2008--How Low to Go in Preventive Cardiology?
JAMA, April 9, 2008; 299(14): 1718 - 1720.
[Full Text] [PDF]

Home page
 J Clin PharmacolHome page
R. A. Preston, P. Harvey, O. Herfert, G. Dykstra, J. W. Jukema, F. Sun, and D. Gillen
A Randomized, Placebo-Controlled Trial to Evaluate the Efficacy, Safety, and Pharmacodynamic Interaction of Coadministered Amlodipine and Atorvastatin in 1660 Patients With Concomitant Hypertension and Dyslipidemia: The Respond Trial
J. Clin. Pharmacol., December 1, 2007; 47(12): 1555 - 1569.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.