When the cardiologists gathered in Chicago at their annual meeting last weekend, they learned about a big new study called HOPE-3. What the scientists and their pharmaceutical sponsor, AstraZeneca, were hoping for was evidence that a single polypill to treat cholesterol and blood pressure would save lives from heart disease. A polypill is a single tablet that contains several medications to achieve the goal.
The HOPE-3 Trial:
The trial was complicated, though, and the results were published in three separate reports in The New England Journal of Medicine.
Lowering Cholesterol:
In the first analysis, scientists compared the rates of heart attack, stroke and cardiovascular death in 12,000 people randomly assigned to take either rosuvastatin (Crestor) or placebo.
None of these folks had heart disease at the beginning of the study, which lasted five to six years. Crestor did its job lowering cholesterol. Those taking this statin reduced their bad LDL cholesterol by about 26 percent compared to those on placebo.
They also were about one-fourth less likely to have a heart attack, a stroke or die. In absolute terms, a little more than one person in 100 got that benefit. It is important to note, though, that there was no significant difference in mortality between volunteers taking Crestor and those on placebo.
The researchers note that a few more people on Crestor than on placebo needed cataract surgery and those on Crestor were more likely to report muscle pain.
New England Journal of Medicine, online April 2, 2016
Lowering Blood Pressure:
The second part of the study randomly assigned the same 12,705 participants to receive a combination blood pressure treatment of candesartan (Atacand) plus hydrochlorothiazide to a look-alike placebo. The data were analyzed to see how well the blood pressure medications worked to reduce the risk of heart attack, stroke or death from cardiovascular causes. In this case, however, the differences between the treatment group and the placebo group were not significant: 4.1% of those on the blood pressure medicine suffered such an event, compared to 4.4% of those on placebo. People who started with systolic blood pressure over 143.5 mm Hg were significantly less likely to have such an outcome if they were on blood pressure drugs instead of placebo. That offers some guidance as to who might benefit most from blood pressure treatment.
New England Journal of Medicine, online April 2, 2016
Combined Treatment of Cholesterol and Blood Pressure:
The third analysis looked at the combination of blood pressure and cholesterol-lowering treatment. This resulted in a significantly lower rate of cardiovascular events among the volunteers on active treatment of Crestor plus blood pressure pills than among those on placebo for both treatments. People taking the active treatment were more likely to report dizziness or muscle weakness.
New England Journal of Medicine, online April 2, 2016
