ASCOT legacy: statins, antihypertensives reduce mortality risks

  • Lancet

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Long-term follow-up results confirm benefits of calcium channel blockers (CCBs) plus statins in protection against cardiovascular disease (CVD)-related, all-cause mortality.
  • The ASCOT Legacy study is a 16-year follow-up of the original ASCOT trial .

Why this matters

  • These authors say that this work is the first report showing long-term benefit of the combination of antihypertensives and statins.

Key results

  • 36.9% of deaths were CVD-related.
  • With antihypertensives only, fewer stroke-related deaths with CCB vs beta-blocker:
    • aHR, 0.71; 95% CI, 0.53-0.97; P=.0305.
  • CCB also bested beta-blocker in nonstatin group in statin/placebo portion of trial:
    • Fewer cardiovascular deaths: aHR, 0.79 (95% CI, 0.67-0.93; P=.0046).
    • Fewer coronary heart disease deaths: aHR, 0.76 (95% CI, 0.59-0.93; P=.0439).
  • Patients receiving antihypertensive plus statin had reduced CVD-related deaths: 
    • HR, 0.85; 95% CI, 0.72-0.99; P=.0395.

Study design

  • Analysis of participants (total for current study, 7302) from the ASCOT trial, which started 16 years ago.
  • ASCOT was multicenter, randomized, with 2×2 factorial design:
    • All patients in BP-lowering arm had either CCB or beta-blocker.
    • Those with low total cholesterol and no lipid-reducing treatment were further included in statin/placebo portion of trial.
  • Funding: Pfizer. 

Limitations

  • No data on nonfatal CVD outcomes or medications taken after the trial ended.
  • Limited to UK residents.

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