ASCOT Legacy: Long-term Survival Benefit of BP and Lipid Lowering Drugs
Blood pressure (BP) and lipid-lowering medications continue to offer survival benefits to hypertensive patients more than a decade after they were taken, the results of a long-term follow-up of data from a landmark trial suggest.
Researchers conducted an analysis of more than 8500 UK patients almost 16 years after they were enrolled in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT).
They showed that patients treated with a regimen based on the calcium channel blocker amlodipine had a 29% reduction in stroke-related death vs those given a regimen based on the β-blocker atenolol, even after just 5.5 years of treatment.
Among patients who went on to be randomly assigned to atorvastatin or placebo, who were treated for 3.3 years, statin therapy was associated with a 15% reduction in rates of cardiovascular death.
Results of the ASCOT Legacy trial, given here at the European Society of Cardiology (ESC) Congress 2018 and published simultaneously in The Lancet, indicate that the benefits of BP- and lipid-lowering therapies accrue over time, even after patients have completed treatment.
As per the study design, this BP-lowering arm (BPLA) of the trial was stopped after a median of 5.5 years because the newer amlodipine therapy prevented more strokes and deaths than the older β-blocker–based regimen.
In the subsequent lipid-lowering arm (LLA) of the trial, 10,305 patients from the original cohort who had nonfasting total cholesterol concentrations of 6.5 mmol/L or less were randomly assigned to additional atorvastatin, 10 mg, or placebo.
Again, the study was stopped after a median of 3.3 years after atorvastatin was shown to be associated with a significantly lower rate of nonfatal myocardial infarction and fatal coronary heart disease (CHD).
Gupta concluded that the findings “confirm the long-term benefits of statin therapy in reducing cardiovascular deaths…even after 13 years of trial closure.”