BACKGROUND:Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. METHODS AND RESULTS:CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure-lowering treatment strategy in the factorial design. CONCLUSIONS:Statin therapy sufficient to significantly reduce cardiovascular events in treated hypertensive patients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT patients in CAFE-LLA.
RCT Entities:
BACKGROUND: Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. METHODS AND RESULTS:CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLApatients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure-lowering treatment strategy in the factorial design. CONCLUSIONS: Statin therapy sufficient to significantly reduce cardiovascular events in treated hypertensivepatients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT patients in CAFE-LLA.
Authors: Matthew R Nelson; Jan Stepanek; Michael Cevette; Michael Covalciuc; R Todd Hurst; A Jamil Tajik Journal: Mayo Clin Proc Date: 2010-05 Impact factor: 7.616
Authors: Xuguang Li; Guangtian Yang; Gang Zhao; Bin Wu; Matthew L Edin; Darryl C Zeldin; Dao Wen Wang Journal: Hypertens Res Date: 2011-05-12 Impact factor: 3.872
Authors: Viachaslau M Barodka; Brijen L Joshi; Dan E Berkowitz; Charles W Hogue; Daniel Nyhan Journal: Anesth Analg Date: 2011-04-07 Impact factor: 5.108
Authors: V Correa; F D Fuchs; L B Moreira; M Gerhardt; S C Fuchs; C R Sloczinski; R G Monteggia; M Gus Journal: J Hum Hypertens Date: 2013-05-16 Impact factor: 3.012
Authors: Julie A Mattison; Mingyi Wang; Michel Bernier; Jing Zhang; Sung-Soo Park; Stuart Maudsley; Steven S An; Lakshmi Santhanam; Bronwen Martin; Shakeela Faulkner; Christopher Morrell; Joseph A Baur; Leonid Peshkin; Danuta Sosnowska; Anna Csiszar; Richard L Herbert; Edward M Tilmont; Zoltan Ungvari; Kevin J Pearson; Edward G Lakatta; Rafael de Cabo Journal: Cell Metab Date: 2014-05-29 Impact factor: 27.287
Authors: Muhammad Ismail Shawish; Bahador Bagheri; Vijaya M Musini; Stephen P Adams; James M Wright Journal: Cochrane Database Syst Rev Date: 2021-01-22