Response to Combination Treatment to Prevent Atherosclerosis
I would like to thank Koh1 for his interest in our article and for presenting his interesting data on the additive beneficial effects of losartan combined with simvastatin in patients with hypercholesterolemia and hypertension.
National Cholesterol Education Program Adult Treatment Panel III guidelines recommend that, for patients at high risk for cardiovascular disease, lipid-lowering therapy should be considered, even at relatively low cholesterol levels (low-density lipoprotein cholesterol ≥100 mg/dL).2 Furthermore, the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm has demonstrated the importance of statin therapy in the primary prevention of major cardiovascular events in people with hypertension and ≥3 cardiovascular risk factors with total cholesterol levels of ≤250 mg/dL (≤6.5 mmol/L).3 The European Society of Cardiology/European Society of Hypertension guidelines recommend a statin for hypertensive patients without overt cardiovascular disease but with high cardiovascular risk, even if their total and low-density lipoprotein cholesterol levels are not elevated.4 The Conduit Artery Functional Endpoint Study, a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial, has demonstrated that statin therapy significantly reduces cardiovascular events in treated hypertensive patients without any influence on central aortic pressures or hemodynamic indices.5 We concur with Koh1 that our present findings are consistent with these from the Conduit Artery Functional Endpoint Study.
Regarding the effect of statins on blood pressure control, an interesting study, the University of California San Diego Statin Study, a randomized, controlled trial assessing the impact of statins on selected noncardiac outcomes, showed that a statin modestly but significantly reduced blood pressure relative to placebo.6 However, the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis Study was not designed to assess noncardiac outcomes or the effect of combination therapy with an antihypertensive drug and a statin. Thus, it is difficult to determine the efficacy of the statin on blood pressure control in this study. However, we can state with certainty that treatment with a statin is advisable to reduce the burden of cardiovascular disease in middle-aged and older patients with hypertension and mildly elevated cholesterol levels.
Koh KK. Combination treatment to prevent atherosclerosis. Hypertension. 2009; 54: e10.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001; 285: 2486–2497.
Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J, for the ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003; 361: 1149–1158.
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Williams B, Lacy PS, Cruickshank JK, Collier D, Hughes AD, Stanton A, Thom S, Thurston H, for the CAFE and ASCOT Investigators. Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study. Circulation. 2009; 119: 53–61.