Early Statin Use Shows Sustained Cardiovascular Benefits

TOPLINE:

Early introduction of atorvastatin vs placebo in patients with hypertension demonstrated significant benefits in reducing cardiovascular disease events, such as non-fatal myocardial infarction (MI) and coronary heart disease (CHD) events, over a 20-year follow-up period.

METHODOLOGY:

• Researchers analysed data from the ASCOT lipid-lowering arm study and included 4605 UK participants with hypertension, at least three additional risk factors for cardiovascular disease, and a total cholesterol level < 6.5 mmol/L.
• Matched patients were randomly assigned to receive either 10 mg atorvastatin (n = 2317; mean age, 64.5 years; 87% men) or placebo (n = 2288; mean age, 64.5 years; 87.6% men).
• Patients had no history of CHD events, transient ischaemic attack, stroke, or treated angina within 3 months before randomisation.
• The primary objective was to compare the time to the first occurrence of cardiovascular disease events, including non-fatal MI and fatal CHD, total coronary events, fatal and non-fatal stroke, fatal and non-fatal heart failure, total cardiovascular disease events, and cardiovascular disease and all-cause mortality, between the two groups.
• The median follow-up duration was 17 years, with a maximum follow-up of up to 21 years.

TAKEAWAY:

• Compared with patients assigned to receive placebo, those assigned to receive atorvastatin demonstrated significant reductions in the occurrence of non-fatal MI and fatal CHD events (adjusted hazard ratio [aHR], 0.81; P = .006), total coronary events (aHR, 0.88; P = .017), and cardiovascular disease mortality (aHR, 0.86; P = .048).
• However, no significant reductions were observed with atorvastatin in terms of the occurrence of heart failure, strokes, total cardiovascular disease events, and all-cause mortality.
• In patients assigned to receive atorvastatin, each unit decrease in the level of low-density lipoprotein-cholesterol was associated with a reduction in the occurrence of all the cardiovascular disease events in the primary objective (P < .01 for all).
• Lipid levels after 2 and 9 years of the trial closure were similar between patients assigned to receive placebo and those assigned to receive atorvastatin.

IN PRACTICE:

“The findings from this and other long-term follow-up trials provide robust evidence for the benefits of early intervention in preventing CV [cardiovascular] outcomes. Delays in initiating statin treatment in individuals at risk of atherosclerotic CV disease result in a continued excess risk of CV events compared with those whose treatment is started earlier,” the authors wrote.

SOURCE:

This study was led by Peter S. Sever, PhD, Imperial College London, London, United Kingdom. It was published online on March 26, 2025, in Heart.

LIMITATIONS:

Follow-up data were accessible for only about half of the patients initially randomly assigned in the lipid-lowering group due to the inaccessibility of electronic records from Nordic countries. The use of diagnostic codes for identifying non-fatal outcomes may have been an additional limitation. Data from electronic hospital records of post-trial events given by National Health Service (NHS) England and Public Health Scotland were unavailable for adjudication.

DISCLOSURES:

This study was funded by Imperial College London, and the original ASCOT study and ASCOT-10 study were funded by Pfizer. Sever reported receiving support from the Biomedical Research Centre Award to Imperial College Healthcare NHS Trust and being a senior investigator for the National Institute for Health Research. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.