Lowering cholesterol, blood pressure, or both to prevent cardiovascular events: results of 8.7 years of follow-up of Heart Outcomes Evaluation Prevention (HOPE)-3 study participants

European Heart Journal, ehab225, https://doi.org/10.1093/eurheartj/ehab225  Published: 08 May 2021
The majority of cardiovascular (CV) events occur in people with no clinical evidence of CV disease (CVD).1 The Heart Outcomes Prevention Evaluation (HOPE)-3 study was designed to determine if a reduction in low-density lipoprotein cholesterol (LDL-C) or blood pressure (BP), either alone or in combination, would reduce CV events in those at intermediate risk with no prior overt clinical CV events.2 After 5.6 years of treatment, rosuvastatin 10 mg daily compared with placebo reduced major adverse CV events (MACE, including myocardial infarction, stroke, or death from CV causes) by 24%.3 Despite reducing systolic BP by 6 mmHg, the combination of candesartan (16 mg daily) and hydrochlorothiazide (12.5 mg daily) compared with placebo did not reduce MACE significantly in the overall trial population. However, a significant reduction in CVD was reported in participants in the upper third of baseline BP [systolic BP >143 mmHg (mean 154 mmHg)].4 Importantly, HOPE-3 included a substantial proportion of non-Caucasians among whom prior data on preventive therapies are limited.