Hypertension Remains a Predictor of Cardiovascular Risk Even After Lipid-Lowering Therapy: Presented at ESH

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Title: Hypertension Remains a Predictor of Cardiovascular Risk Even After Lipid-Lowering Therapy: Presented at ESH
URL: http://www.pslgroup.com/dg/223C7E.htm
Doctor's Guide
June 18, 2008

By Betty S. Riggs

BERLIN -- June 18, 2008 -- A new analysis of data from the Treating to New Targets (TNT) study demonstrates that intensive management of both blood pressure and low-density lipoprotein cholesterol (LDL-C) is critical for reducing the risk of cardiovascular events in patients with coronary heart disease (CHD) and the metabolic syndrome.

Prakash Deedwania, MD, Veterans Administration Central California Healthcare System and University of California at San Francisco, San Francisco, California, and colleagues reported their findings here on June 17 at the 18th Scientific Meeting of the European Society of Hypertension (ESH).

The TNT study was conducted at approximately 256 sites in 14 countries and included 10,001 patients with clinically evident CHD and LDL-C levels of less than 130 mg/dL (3.4 mmol/L). Eligible patients were randomised to double-blind treatment with atorvastatin at either 10 or 80 mg per day and followed for a median of 4.9 years.

The primary endpoint was the occurrence of a major cardiovascular (CV) event, defined as death from CHD, nonfatal, non-procedure-related myocardial infarction, resuscitation after cardiac arrest, or fatal or nonfatal stroke.

Mean on-treatment LDL-C levels were 101 mg/dL (2.6 mmol/L) with atorvastatin 10 mg and 77 mg/dL (2.0 mmol/L) with atorvastatin 80 mg. Major CV events occurred in 548 of the low-dose patients and 434 of the high-dose patients (hazard ratio [HR] = 0.78, 95% confidence intervals [CI], 0.69-0.89; P < .001).

The main results of the TNT study previously showed that intensive lipid-lowering therapy with 80 mg of atorvastatin daily in patients with stable CHD provides significant clinical benefit beyond that which is seen with 10 mg of atorvastatin daily.

In the new analysis of TNT data, researchers compared the impact of intensive lipid-lowering therapy with atorvastatin 80 mg daily on CV risk associated with hypertension and on other components of the metabolic syndrome, including body mass index, triglycerides, high-density lipoprotein cholesterol (HDL-C), and fasting glucose. They used a log-rank test to test the statistical significance of components of the metabolic syndrome on endpoints, and HRs and CIs were calculated using a Cox regression model.

In patients treated with atorvastatin 10 mg, the presence of each component of metabolic syndrome significantly increased the risk of major CV events (P < .0001). This effect was attenuated in the high-dose group, that is, there was a greater reduction in absolute risk for each additional component of the metabolic syndrome, although the trend remained significant (P < .0001).

When all possible statistical models with 2 or 3 components of the metabolic syndrome were assessed, hypertension was present as one of the best predictors of CV risk in patients treated with atorvastatin at either 10 or 80 mg.

Dr. Deedwania stated, "Physicians tend to compartmentalise therapy, focusing mainly on lowering cholesterol in this patient population. The main message from this analysis is that both cholesterol and blood pressure need to be controlled in order to reduce the risk of cardiovascular events in patients with stable CHD and metabolic syndrome."

The results for the primary data analysis of TNT were previously published in 2005 (LaRosa JC et al. N Engl J Med. 2005;352:1425-1435).

Funding for this study was provided by Pfizer, Inc.

[Presentation title: Hypertension Remains a Powerful Predictor for Cardiovascular Risk Even After Intensive Lipid-Lowering Therapy. Abstract PS23]

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