NEW YORK — Both blood pressure control and lipid lowering independently cut the rate of cardiovascular disease events in a post hoc analysis of data collected in a study with about 10,000 patients.
In patients with stable coronary artery disease, lowering serum levels of LDL cholesterol to less than 74 mg/dL, and maintaining systolic BP at less than 140 mm Hg, led to the lowest rate of major cardiovascular disease events during a median follow-up of almost 5 years, Dr. John B. Kostis reported at the annual meeting of the American Society of Hypertension.
The analysis also showed no interaction between blood pressure control and lipid lowering. Lipid lowering had a similar effect on the rate of cardiovascular events in patients with either controlled or uncontrolled blood pressure levels, and controlled pressure was effective at reducing events at all LDL levels, said Dr. Kostis, chairman of medicine at Robert Wood Johnson Medical School, Piscataway, N.J.
“Intensive management of both LDL cholesterol and blood pressure is important in patients with stable coronary heart disease,” he said. The analysis did not find differences in the effects of reduced blood pressure on the basis of the classes of antihypertensive drugs used.
The data came from the Treating to New Targets (TNT) study, which compared the effect of two different dosages of atorvastatin, 10 mg or 80 mg per day, on the incidence of cardiovascular events in patients with stable coronary artery disease. The main result, reported last year, was that treatment with the higher dosage was linked with a 2.2% absolute reduction in events (N. Engl. J. Med. 2005;352:1425-35). The TNT study was sponsored by Pfizer, which markets atorvastatin (Lipitor). Dr. Kostis is a consultant to, a speaker for, and a grant recipient from Pfizer.
The post hoc analysis examined the interaction of blood pressure and serum levels of LDL cholesterol. The analysis focused on the blood pressure and lipid levels measured after the first 3 months of treatment. Full data were available for about 9,700 patients.
During almost 5 years of follow-up, the lowest rate of major cardiovascular events was 7.1%, in patients who had a serum LDL cholesterol level of less than 74 mg/dL—the lowest tertile—and a systolic pressure of less than 140 mm Hg. Events counted included fatal and nonfatal strokes, and fatal and nonfatal coronary disease events. The highest rate was 12.3%, in patients in the highest tertile for serum LDL cholesterol—more than 94 mg/dL—and in patients with a systolic pressure of at least 140 mm Hg. (See chart.)
Lipid lowering had a similar effect on the cardiovascular event rate in either controlled or uncontrolled blood pressure. DR. KOSTIS
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