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Statin effectiveness: ASCOT update

 

Clinical bottom line

The addition of one more large randomised study of the effect of statins on outcomes confirms the results of earlier studies.


Background

The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) involved over 19,000 patients with hypertension and at least three other cardiovascular risk factors, who were randomised to one of two antihypertensive treatments. The lipid-lowering arm (LLA) of the trial comprised 10,305 patients with non-fasting total cholesterol levels of 6.5 mmol/L or less, who were randomised to additional treatment with atorvastatin (10 mg daily) or placebo. Follow up was planned for five years, but the study was stopped after a median of 3.3 years.

The results of this trial have been added to a previous summary of statin outcome trials.

Reference


PS Sever et al. 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 trial. Lancet 2003; 361: 1149-1158.


Results

The main outcomes from the ASCOT trial are shown in Table 1. In Table 2, these outcomes have been added to the results of the previous summary.

Table 1: Main outcomes of ASCOT-LLA

Event
atorvastatin
placebo
Total numbers of participants
5168
5137
All CHD
86
137
All stroke
89
121
All CHD + stroke
175
258
All cause death
185
212
CV death
74
82
All CHD: non-fatal MI (excl silent MI) + fatal CHD
All stroke: non-fatal and fatal stroke

Table 2: Pooled results from large statin outcome trials


Event
Trials
Participants
RR (95% CI)
NNT (95% CI)
All CHD
7
61658
0.73 (0.70-0.77)
33 (29-39)
Non-fatal CHD
6
51353
0.71 (0.66-0.76)
47 (39-58)
All stroke
6
55053
0.76 (0.70-0.83)
101 (77-149)
Non-fatal stroke
5
44748
0.74 (0.67-0.82)
95 (72-140)
All CHD and stroke
6
55053
0.74 (0.71-0.77)
26 (23-31)
All cause death
7
61658
0.85 (0.81-0.89)
67 (51-96)
All bad things
5
44748
0.78 (0.75-0.81)
19 (17-23)

Comment

These additional results have made little difference to the overall assessment of how effective statins are in reducing heart attacks and strokes, whether they are fatal or nonfatal.