Risk of Heart Attack Significantly Reduced in About 90 days by Modern Combination of Drugs

Risk of Heart Attack Significantly Reduced in About 90 days by Modern Combination of Drugs

December 04, 2006

    -- New Results From the Only Large European Study
Combining Blood
       Pressure-Lowering With Cholesterol Reduction in
Patients With 
       Moderate Cardiac Risk Prevents Half of Heart
Attacks


    LONDON, Dec. 4 /Xinhua-PRNewswire/ -- The risk of heart
attack can be reduced by more than 50 percent by combining a
cholesterol-reducing drug, atorvastatin calcium, with a
blood pressure-lowering drug, amlodipine besylate, and the
benefits are evident for heart attacks as early as 90 days
after the start of treatment.

    Additionally, in the trial, the simultaneous initiation
of atorvastatin and amlodipine treatment was about three
times more effective at preventing heart attacks than
adding atorvastatin, a statin, to one of the world's most
widely used blood pressure-lowering drugs, atenolol, a
beta-blocker.

    For the first time, results from a large trial -- the
Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), which
recruited >19,000 patients in the UK, Ireland and the
Nordic countries -- show that the addition of atorvastatin
to amlodipine (a calcium channel blocker) reduced the risk
of fatal and non-fatal cardiac events by 53%, and clinical
benefits were evident after only three months' treatment
(p=0.02). This contrasted with the addition of atorvastatin
to atenolol, which only achieved a non-significant 16%
reduction by the end of the study (median 3.3 years),
according to a paper published on-line in the European
Heart Journal today. (See Figure 1)

    According to a principal ASCOT investigator, Professor
Peter Sever of the International Centre for Circulatory
Health, Imperial College, London, UK, these results have
major implications for physicians and their patients
worldwide.

    "ASCOT demonstrates that the risk of heart attacks
can be more than halved in the many patients at moderate
risk who doctors see every day. In addition, there is a
reduction in strokes of >25 percent. This is achieved by
combining two well-known and widely-used drugs -- amlodipine
and atorvastatin. 

    "However, if we continue to use older blood
pressure-lowering drugs, such as atenolol, and choose only
to treat high blood pressure in isolation without giving a
statin, we only confer a small part of this potential
benefit. As a result, the risk of heart attacks and strokes
remains unacceptably high in too many patients despite
treatment to blood pressure targets," Professor Sever
said.

    Results establish important hypothesis for future
research

    The differences in risk reduction between the two
treatments may be explained by recent and ongoing
laboratory studies. Earlier laboratory research and
clinical studies suggest that amlodipine and atorvastatin
may stabilize the fatty deposits in the walls of the
arteries (atherosclerotic plaques) which can rupture to
cause cardiovascular events such as heart attacks.

    Professor Sever said: "The new data generate an
important hypothesis that suggests a synergistic effect
between atorvastatin calcium and amlodipine besylate, which
goes beyond the effects of the individual drugs. This is an
exciting possibility for future research, which we and
other groups will be exploring."

    The future of treatment

    The ASCOT Study is resulting in a re-evaluation of the
management of patients with a moderately increased risk of
cardiac events worldwide. The importance of combining a
contemporary blood pressure drug regimen based on a calcium
channel blocker with a statin is gaining importance.
Meanwhile, the use of beta-blockers -- except where they
are specifically indicated -- is being questioned.

    "For the first time, these important data show
that the selection of a blood pressure-lowering drug
regimen combined with a statin may have significant
clinical implications for preventing heart attacks. It is
vital that we use the right combination from the start to
maximize the reduction in cardiac risk," Professor
Sever said.

    Note to Editors

    To view Figure 1 please register at PR Newswire for
Journalists (PRNJ)
    http://www.prnewswire.com/media 

    About cardiovascular risk

    More that 330 million adults in Europe and North
America suffer from high blood pressure, which also affects
an additional 639 million men and women in the rest of the
world. (The Lancet, January 2005)
    
    About 80% of people with high blood pressure have
additional uncontrolled cardiovascular risks. (World Health
Organisation).

    About ASCOT

    ASCOT is the largest European study of people with high
blood pressure and > 3 additional common cardiac risk
factors, e.g. history of smoking, age > 55 years,
diabetes, lipid abnormalities, etc. It included more than
19,000 men and women with high blood pressure who were at a
moderate risk of strokes and heart attacks and without
previous history of heart disease. To control their blood
pressure, they received either the newer drug -- a calcium
channel blocker, amlodipine besylate -- or a beta-blocker,
atenolol, to which the ACE inhibitor perindopril or the
diuretic bendroflumethiazide were added, respectively, if
necessary, to control the BP. Additionally, 10,000 patients
also were treated with the cholesterol-lowering drug
atorvastatin calcium or a placebo (dummy pill). This is the
only major European study to date to combine these two
treatment strategies.

    The most commonly seen adverse events (AEs) in the
amlodipine regimen were peripheral oedema and cough. The
most commonly seen AEs in the atenolol regimen were
dizziness and fatigue. No new, unexpected AEs were observed
beyond those seen in previously published ASCOT results.
Further details can be found at the ASCOT Web site,
http://www.ascotstudy.org

    Potential synergy between lipid-lowering and blood
pressure-lowering in the Anglo-Scandinavian Cardiac
Outcomes Trial Lipid-Lowering Arm

    Peter Sever, Bjorn Dahlof, Neil Poulter, Hans Wedel,
Gareth Beevers, Mark Caulfield, Rory Collins, Sverre
Kjeldsen, Arni Kristinsson, Gordon McInnes, Jesper Mehlsen,
Markku Nieminem, Eoin O'Brien and Jan Ostergren
    European Heart Journal 2006, Volume 27; 24: 2982-2988

    Executive Committee of the ASCOT Trial

    Peter S Sever
    Professor of Clinical Pharmacology & Therapeutics
    International Centre for Circulatory Health
    National Heart and Lung Institute
    Imperial College, London
    & St Mary's Hospital, London, UK
    Email: [e-mail]

    Bjorn Dahlof
    Associate Professor
    Department of Medicine
    Sahlgrenska University Hospital/Ostra
    University of Gothenburg, Sweden
    Email: [e-mail]

    Neil R Poulter
    Professor of Preventive Cardiovascular Medicine
    International Centre for Circulatory Health
    National Heart and Lung Institute
    Imperial College, London, UK
    Email: [e-mail]

    Hans Wedel
    Professor of Epidemiology
    Biostatistics
    Nordic School of Public Health
    Gothenburg, Sweden
    Email: [e-mail]
   
    For more information, please contact:

     Alison Davies
     MediNews International
     Tel:    [phone] 
     Mobile: [phone]
     Email:  [e-mail]

     Michael W Gibbs
     MediNews International 
     Tel:    [phone]
     Mobile: [phone]
     Email:  [e-mail]

SOURCE  Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)