New heart study shows use of statins effective in reducing heart disease in patients without symptoms

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At the annual American College of Cardiology meeting in Chicago heart specialists from all over the world gathered to hear about new studies that have just finished.  One of the most important trials from the meeting was the HOPE-3 Trial.

The HOPE-3 trial was a randomized, double-blind, placebo controlled trial, the best type of research available, and looked at 12,700 people who were followed for 5.6 years.  All of the people had a risk factor for heart disease like hypertension, smoking, or diabetes but they did not have a heart attack, stroke, or signs of heart disease yet.  They evaluated the impact of lipid lowering with a statin, blood pressure control with moderate doses of two drugs, combined statin plus blood pressure lowering, or neither therapy.

They found that in people with heart disease risk but no signs of heart disease that the long term use of statins was associated with a 26% reduction in the risk of cardiovascular disease, blood pressure reduction only reduced cardiovascular risk by 6%, and the combination of the two regimens only reduced the risk by 28%, almost the same a statin alone.  In the people whose systolic blood pressures were above 140mmHg, which denoted the level where hypertensive patients require treatment according to guidelines, the statin and the blood pressure medications worked together to reduce the risk by 40% which is even more than either therapy alone which only reduced risk by 20-26%.

Millions of Americans have obesity, smoke, or have hypertension and diabetes but have never had angina chest pain, a heart attack, or a stroke.  This study shows that there is a benefit to using a statin in these patients regardless of their blood pressure.  For people with hypertension, following guidelines and starting antihypertensive medications when the systolic blood pressure hits 140mmHg is supported by this trial, these people also benefit from statin therapy, but if your systolic blood pressure is not that high, giving them blood pressure medications will not provide any real benefits.  This supports other trials that have previously found that reducing systolic blood pressure to below 140mmHg is beneficial but driving people’s systolic blood pressure down to normal, below 120mmHg does not provide additional benefit.