HOPE-3: Blood Pressure, Cholesterol Lowering Evaluated in Intermediate-Risk Patients

He urged, “We have to simplify prevention. Otherwise, it will not be used widely.”

Valentin Fuster, MD, editor-in-chief of the Journal of the American College of Cardiology, echoed that sentiment. “The future of prevention is no doubt in simplicity,” he remarked at the ACC press conference. “It’s fascinating that you [HOPE-3 investigators] designed such a complex trial to reach simplicity.”  

Dr Yusuf added that although this was the first formal testing of a polypill concept on clinical events, more trials are needed to study the intermediate-risk patient population. 

In an interview with Cardiology Advisor, B. Hadley Wilson, MD, FACC, of the Sanger Heart & Vascular Institute at Carolinas HealthCare System in Charlotte, elaborated on the cost-benefit analysis. “I think we won’t be surprised to see that by reducing these catastrophes in large populations, that we will see a benefit to population health,” he said. “And as we go forward, more studies will be done — maybe even more targeted polypill therapy, if you will, to these high-risk populations [to] see if they also benefit over time.”

While the HOPE-3 findings may appear to encourage a “one-size fits all” approach to antihypertensive and lipid-lowering therapy, all 3 investigators insisted that individualized care is paramount.

“Our findings contradict the ‘lower is better’ hypothesis that has been derived from epidemiologic studies and our findings support the concept that a J-curve phenomenon exists for major CV events, other than for stroke, in this population,” the researchers concluded in 1 of their 3 published reports. “…Our data are compatible with the hypothesis that treating persons without CVD who have a systolic blood pressure above approximately 140 mm Hg appears to be beneficial, but treatment would not be of benefit and may be even harmful in persons with lower systolic blood pressure levels.”

References

1. Bosch J, HOPE-3 Investigators. Abstract 401-18. Effects of rosuvastatin on cardiovascular disease in moderate risk primary prevention in diverse ethnic groups. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.
2. Lonn EM, Bosch J, Lopez-Jaramillo P, et al; for the HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016. doi:10.1056/NEJMoa1600175.
3. Lonn EM, HOPE-3 Investigators. Abstract 401-17. Blood pressure lowering in people at moderate risk. The HOPE-3 trial. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.
4. Yusuf S, Bosch J, Dagenais G, et al; for the HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. doi:10.1056/NEJMoa1600176.
5. Yusuf S, HOPE-3 Investigators. Abstract 401-19. Effects of combined lipid and BP-lowering on cardiovascular disease in a moderate risk global primary prevention population. Presented at: ACC 65th Scientific Sessions; April 2-4, 2016; Chicago, IL.
6. Yusuf S, Lonn E, Pais P, et al; for the HOPE-3 Investigators. Blood-pressure and cholesterol lowering in people without cardiovascular disease. N Engl J Med. doi:10.1056/NEJMoa1600177.

This article originally appeared on The Cardiology Advisor