Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA)

What Effect does Atorvastatin produce in Hypertensive Patients who have Average or Lower-than-average Cholesterol Concentrations?

Results of the Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm

Original Citation

Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Östergren J, for the ASCOT investigators. 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. Lancet 2003;361:1149-58

Overall Study Question

These investigators compared atorvastatin 10 mg to placebo in the prevention of non-fatal myocardial infarction and fatal coronary heart disease.

Patients

10,305 patients with a total cholesterol <6.5 mmol/L. All patients had hypertension, 81% were male, 33% were smokers, and 25% had diabetes. Their average age was 63.

Treatment

Patients were randomized in a blinded fashion to receive either atorvastatin 10 mg or placebo daily.

Duration

The trial was stopped after a median follow up of 3.3 years.

Results

Cholesterol differences at end of follow-up (mmol/L)

Total – atorvastatin 4.21, placebo 5.21

LDL – atorvastatin 2.32, placebo 3.27

HDL – atorvastatin 1.31, placebo 1.29

Triglycerides – atorvastatin 1.29, placebo 1.49

How does this study contribute to the drug therapy of patients patients with hypertension and average cholesterol?

This study suggests that atorvastatin at a dose of 10 mg decreases the chance of non fatal MI plus fatal CHD, fatal plus non-fatal stroke and total cardiovascular events in hypertensive patients with a total cholesterol below 6.5 mmol/L (average 5.5 mmol/L). Overall mortality was not affected over the 3.3 year period.

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