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
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| Total numbers of participants | ||
| All CHD | ||
| All stroke | ||
| All CHD + stroke | ||
| All cause death | ||
| CV death | ||
| 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
| All CHD |
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| Non-fatal CHD |
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| All stroke |
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| Non-fatal stroke |
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| All CHD and stroke |
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| All cause death | ||||
| All bad things |
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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.