Effects of Lipid-Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE-3 Trial.

Abstract

BACKGROUND:

It is not clear whether the effects of lipid-lowering or antihypertensive medications are influenced by adherence to healthy lifestyle factors. We assessed the effects of both drug interventions in subgroups by the number of healthy lifestyle factors in participants in the HOPE-3 (Heart Outcomes Prevention Evaluation) trial.

METHODS AND RESULTS:

In this primary prevention trial, 4 healthy lifestyle factors (nonsmoking status, physical activity, optimal body weight, and healthy diet) were recorded in 12 521 participants who were at intermediate risk of cardiovascular disease (CVD) and were randomized to rosuvastatin, candesartan/hydrochlorothiazide, their combination, or matched placebos. Median follow-up was 5.6 years. The outcome was a composite of CVD events. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. Participants with ≥2 healthy lifestyle factors had a lower rate of CVD compared with those with fewer factors (HR: 0.85; 95% CI, 0.73-1.00). Rosuvastatin reduced CVD events in participants with ≥2 healthy lifestyle factors (HR: 0.74; 95% CI, 0.62-0.90) and in participants with <2 factors (HR: 0.79; 95% CI, 0.61-1.01). Consistent results were observed with combination therapy (≥2 factors: HR: 0.74; 95% CI, 0.57-0.97; <2 factors: HR: 0.61; 95% CI, 0.43-0.88). Candesartan/hydrochlorothiazide tends to reduce CVD only in participants with <2 healthy lifestyle factors (HR: 0.78; 95% CI, 0.61-1.00).

CONCLUSIONS:

Healthy lifestyles are associated with lower CVD. Rosuvastatin alone and combined with candesartan/hydrochlorothiazide is beneficial regardless of healthy lifestyle status; however, the benefit of antihypertensive treatment appears to be limited to patients with less healthy lifestyles.

CLINICAL TRIAL REGISTRATION:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT00239681.

• Authors: Gilles R Dagenais, Hyejung Jung, Eva Lonn, Peter M Bogaty, Mahshid Dehghan, Claes Held, Alvaro Avezum, Petr Jansky, Matyàs Keltai, Lawrence A Leiter, Patricio Lopez-Jaramillo, William D Toff, Jackie Bosch, Salim Yusuf
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 7 Issue 15 (07 22 2018) ISSN: 2047-9980 [Electronic] England
• PMID: 30033433 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Chemical References

• Anticholesteremic Agents
• Antihypertensive Agents
• Benzimidazoles
• Biphenyl Compounds
• Cholesterol, LDL
• Tetrazoles
• Hydrochlorothiazide
• Rosuvastatin Calcium
• candesartan

Topics

• Aged
• Anticholesteremic Agents (therapeutic use)
• Antihypertensive Agents (therapeutic use)
• Benzimidazoles (therapeutic use)
• Biphenyl Compounds
• Cardiovascular Diseases (blood, prevention & control)
• Cholesterol, LDL (blood)
• Double-Blind Method
• Drug Therapy, Combination
• Female
• Healthy Lifestyle
• Humans
• Hydrochlorothiazide (therapeutic use)
• Male
• Middle Aged
• Primary Prevention (methods)
• Risk Factors
• Rosuvastatin Calcium (therapeutic use)
• Tetrazoles (therapeutic use)
• Treatment Outcome