Sever Peter S, Rostamian Somayeh, Whiteley William, Ariti Cono, Godec Thomas, Gupta Ajay, Mackay Judith, Whitehouse Andrew, Poulter Neil R
National Heart & Lung Institute, Imperial College London, London, UK
National Heart & Lung Institute, Imperial College London, London, UK.
Heart. 2025 Jul 28;111(16):769-775. doi: 10.1136/heartjnl-2024-325104.
Cardiovascular (CV) deaths were reduced by atorvastatin during a 16-year follow-up of participants in the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm. We now extend these observations over 20 years and report both non-fatal and fatal CV outcomes.
A cohort of 4605 UK hypertensive participants with total cholesterol <6.5 mmol/L (2317 atorvastatin vs 2288 placebo) was followed for up to 21 years (IQR 9.1-19.3). Cox proportional hazard models assessed HRs for non-fatal and fatal CV events. At the end of the original trial (3.3 years), all participants were offered atorvastatin. Lipid profiles were obtained from all subjects 2 years later and from subgroups approximately 9 years post-trial.
Patients allocated to atorvastatin had a significant reduction in non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) events (HR (95% CI) 0.81 (0.69 to 0.94, p=0.006)), total coronary events (0.88 (0.80 to 0.98, p=0.017)) and CV deaths (0.86 (0.74 to 0.99, p=0.048)). No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality was observed.In participants assigned atorvastatin in the trial, 3-year mean low-density lipoprotein-cholesterol was strongly associated with long-term CV outcomes. The HRs per 1 mmol/L decrease were for non-fatal MI and fatal CHD (0.69 (0.57 to 0.85, p<0.001)), total coronary events (0.70 (0.61 to 0.79, p<0.001)), non-fatal and fatal HF (0.68 (0.57 to 0.81, p<0.001)), non-fatal and fatal stroke (0.74 (0.59 to 0.92, p=0.006)), total CV events and procedures (0.74 (0.66 to 0.81, p<0.001)), CV mortality (0.66 (0.55 to 0.81, p<0.001)) and all-cause mortality (0.81 (0.71 to 0.90, p<0.001)).Two years after the trial, approximately two-thirds of subjects in each arm were taking atorvastatin. At this time point and approximately 9 years post-trial, lipid profiles were similar between those formerly assigned atorvastatin or placebo.
These observations provide further evidence for the long-term legacy effects of statins and have implications for the early introduction of statins to prevent CV events and mortality.
在盎格鲁-斯堪的纳维亚心脏结局试验降脂组参与者的16年随访期间，阿托伐他汀降低了心血管（CV）死亡风险。我们现在将这些观察结果扩展至20年，并报告非致命性和致命性CV结局。
对4605名英国高血压患者进行队列研究，这些患者的总胆固醇<6.5 mmol/L（2317名服用阿托伐他汀，2288名服用安慰剂），随访长达21年（四分位间距9.1 - 19.3年）。Cox比例风险模型评估非致命性和致命性CV事件的风险比（HR）。在原试验结束时（3.3年），所有参与者均被给予阿托伐他汀。2年后从所有受试者获取血脂谱，并在试验后约9年从亚组中获取。
分配至阿托伐他汀组的患者非致命性心肌梗死（MI）和致命性冠心病（CHD）事件显著减少（HR（95%CI）0.81（0.69至0.94，p = 0.006）），总冠心病事件（0.88（0.
