[Pharmacological primary prevention of myocardial infarction, stroke and death: A possible task?]

Area of Science:

• Cardiology
• Pharmacology
• Preventive Medicine

Background:

• The HOPE-3 Trial assessed primary prevention of cardio- and neurovascular events in intermediate-risk patients without established atherosclerotic disease.
• Investigated the efficacy of Rosuvastatin and Candesartan/HCT, alone and in combination, versus placebo.

Purpose of the Study:

• To evaluate the effectiveness of Rosuvastatin and Candesartan/HCT in reducing primary composite endpoints of cardiovascular and neurovascular events.
• To determine the impact of these interventions on mortality and identify specific patient subgroups who may benefit.

Main Methods:

• A factorial design trial involving Rosuvastatin 10 mg and Candesartan 16 mg/HCT 12.5 mg or placebo.
• Included patients with intermediate cardiovascular risk but without known atherosclerotic disease.
• Assessed outcomes including cardio- and neurovascular events and mortality.

Main Results:

• Rosuvastatin significantly lowered LDL-cholesterol and reduced cardio- and neurovascular events (NNT ~500/year) without affecting mortality.
• Candesartan/HCT showed no overall benefit but a positive effect in a subgroup with Stage I hypertension; higher risk was observed in patients with systolic pressure <131 mmHg.
• Combination therapy offered no additive benefits beyond statin therapy alone.

Conclusions:

• Primary prevention with Rosuvastatin is recommended for individuals with a 1-2% annual cardio- and neurovascular risk, irrespective of baseline LDL-cholesterol.
• Candesartan/HCT is beneficial only in hypertensive patients; further research on different antihypertensives is warranted.
• Combining statins and antihypertensives in a poly-pill for primary prevention in normotensive, intermediate-risk individuals is not advised.