Heart Outcomes Prevention Evaluation (HOPE)-3 was a double-blind,
randomized, placebo-controlled trial, in an international, ethnically diverse population (n= 12,705 from 21 countries) at intermediate
risk who did not have cardiovascular (CV) disease. The results are published in the NEJM
in three articles:
i) blood-pressure lowering (candesartan, 16 mg per day, plus hydrochlorothiazide, 12.5 mg per day), ii) cholesterol lowering (rosuvastatin,
10 mg per day) and iii) combination trial (rosuvastatin and candesartan plus hydrochlorothiazide). Follow up was a median of 5.6 years.
Rosuvastatin at a dose of 10 mg per day resulted in a significantly lower risk of CV event-related death, non-fatal myocardial infarction,
or non-fatal stroke than placebo. The cholesterol lowering component of the trial showed that a reduction of 1 mmol per litre in the LDL
cholesterol level was associated with a 25% lower risk of CV events. The blood-pressure lowering component of the trial showed no significant
benefit of anti-hypertensive therapy in reducing the risk of CV events. The results of the combined intervention generally agreed with the
results for the separate interventions. There was no evidence of harm or synergy between the interventions. The results provide support for
the use of statins as a safe and effective intervention to prevent CV events in patients at intermediate risk without CV disease.
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