Effects of Lipid‐Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE‐3 Trial

Abstract

BackgroundIt is not clear whether the effects of lipid‐lowering or antihypertensive medications are influenced by adherence to healthy lifestyle factors. We assessed the effects of both drug interventions in subgroups by the number of healthy lifestyle factors in participants in the HOPE‐3 (Heart Outcomes Prevention Evaluation) trial.Methods and ResultsIn this primary prevention trial, 4 healthy lifestyle factors (nonsmoking status, physical activity, optimal body weight, and healthy diet) were recorded in 12 521 participants who were at intermediate risk of cardiovascular disease (CVD) and were randomized to rosuvastatin, candesartan/hydrochlorothiazide, their combination, or matched placebos. Median follow‐up was 5.6 years. The outcome was a composite of CVD events. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. Participants with ≥2 healthy lifestyle factors had a lower rate of CVD compared with those with fewer factors (HR: 0.85; 95% CI, 0.73–1.00). Rosuvastatin reduced CVD events in participants with ≥2 healthy lifestyle factors (HR: 0.74; 95% CI, 0.62–0.90) and in participants with <2 factors (HR: 0.79; 95% CI, 0.61–1.01). Consistent results were observed with combination therapy (≥2 factors: HR: 0.74; 95% CI, 0.57–0.97; <2 factors: HR: 0.61; 95% CI, 0.43–0.88). Candesartan/hydrochlorothiazide tends to reduce CVD only in participants with <2 healthy lifestyle factors (HR: 0.78; 95% CI, 0.61–1.00).ConclusionsHealthy lifestyles are associated with lower CVD. Rosuvastatin alone and combined with candesartan/hydrochlorothiazide is beneficial regardless of healthy lifestyle status; however, the benefit of antihypertensive treatment appears to be limited to patients with less healthy lifestyles.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00239681.

Impact of blood pressure lowering, cholesterol lowering and their combination in Asians and non-Asians in those without cardiovascular disease: an analysis of the HOPE 3 study

“…The impact of adherence or otherwise to a healthy lifestyle has not been addressed in this analysis. Such an analysis in the entire HOPE 3 study population 12 assessed the effect of drug interactions in subgroups by adherence to two or more of four healthy lifestyle factors – (non-smoking (never smokers and those who had quit more than a year earlier) versus current smoking; moderate or vigorous physical activities versus less activity; optimal waist/hip ratio (≤0.89 for men and ≤0.84 for women) versus a higher ratio and a healthy versus unhealthy diet, assessed using a 9-point Mediterranean diet score) with those with less than two. This analysis reported that those who had two or more of these factors had overall lower rates of cardiovascular events (HR 0.85, 95% CI 0.73–1.00).…”