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Title: Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease
Authors: Yusuf, S.
Bosch, J.
Dagenais, G.
Zhu, J.
Xavier, D.
Liu, L.
Pais, P.
López-Jaramillo, P.
Leiter, L. A.
Dans, A.
Avezum, A.
Piegas, L. S.
Parkhomenko, A.
Keltai, K.
Keltai, M.
Sliwa, K.
Peters, R. J.
Held, C.
Chazova, I.
Yusoff, K.
Lewis, B. S.
Jansky, P.
Khunti, Kamlesh
Toff, William D.
Reid, C. M.
Varigos, J.
Sanchez-Vallejo, G.
McKelvie, R.
Pogue, J.
Jung, H.
Gao, P.
Diaz, R.
Lonn, E.
HOPE-3 Investigators
First Published: 2-Apr-2016
Publisher: Massachusetts Medical Society
Citation: New England Journal of Medicine, 2016, 374 (21), pp. 2021-2031
Abstract: BACKGROUND: Previous trials have shown that the use of statins to lower cholesterol reduces the risk of cardiovascular events among persons without cardiovascular disease. Those trials have involved persons with elevated lipid levels or inflammatory markers and involved mainly white persons. It is unclear whether the benefits of statins can be extended to an intermediate-risk, ethnically diverse population without cardiovascular disease. METHODS: In one comparison from a 2-by-2 factorial trial, we randomly assigned 12,705 participants in 21 countries who did not have cardiovascular disease and were at intermediate risk to receive rosuvastatin at a dose of 10 mg per day or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke, and the second coprimary outcome additionally included revascularization, heart failure, and resuscitated cardiac arrest. The median follow-up was 5.6 years. RESULTS: The overall mean low-density lipoprotein cholesterol level was 26.5% lower in the rosuvastatin group than in the placebo group. The first coprimary outcome occurred in 235 participants (3.7%) in the rosuvastatin group and in 304 participants (4.8%) in the placebo group (hazard ratio, 0.76; 95% confidence interval [CI], 0.64 to 0.91; P=0.002). The results for the second coprimary outcome were consistent with the results for the first (occurring in 277 participants [4.4%] in the rosuvastatin group and in 363 participants [5.7%] in the placebo group; hazard ratio, 0.75; 95% CI, 0.64 to 0.88; P<0.001). The results were also consistent in subgroups defined according to cardiovascular risk at baseline, lipid level, C-reactive protein level, blood pressure, and race or ethnic group. In the rosuvastatin group, there was no excess of diabetes or cancers, but there was an excess of cataract surgery (in 3.8% of the participants, vs. 3.1% in the placebo group; P=0.02) and muscle symptoms (in 5.8% of the participants, vs. 4.7% in the placebo group; P=0.005). CONCLUSIONS: Treatment with rosuvastatin at a dose of 10 mg per day resulted in a significantly lower risk of cardiovascular events than placebo in an intermediate-risk, ethnically diverse population without cardiovascular disease. (Funded by the Canadian Institutes of Health Research and AstraZeneca; HOPE-3 number, NCT00468923.).
DOI Link: 10.1056/NEJMoa1600176
eISSN: 1533-4406
Version: Publisher Version
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2016 Massachusetts Medical Society. All rights reserved. Deposited with reference to the publisher’s open access archiving policy.
Description: the file associated with this record is under embargo for 6 months from first publication.
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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