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Highlight on the Heart Outcomes Prevention Evaluation-3 study

The Heart Outcomes Prevention Evaluation (HOPE)-3 study is an international randomized trial conducted in 21 countries. It aimed to assess the safety and efficacy of cholesterol lowering and/or blood pressure lowering, in patients without known cardiovascular disease, and with an intermediate risk of major cardiovascular events. Read this short review from Dr Dimitri Richter (FESC).

HOPE-3 study enrolled more than 12 000 people from around the world. Almost one third was Chinese and South Asian. They included men over age 55 years and women over age 65 years with at least one risk factor for heart disease.

The study had a 2×2 factorial design. In the first arm of the study, participants were randomly assigned to receive placebo or a low dose of a candesartan/hydrochlorothiazide combination. Then, in the second arm, they were again randomly assigned to receive rosuvastatin 10 mg or placebo. Investigators analyzed the blood pressure changes, then the cholesterol changes, and finally blood pressure and cholesterol levels in those who received both treatments vs placebo.

Treatment was not dictated by blood pressure or cholesterol levels but just by age and the presence of one additional risk factor.
The blood pressure arm of the study showed absolutely no benefit for lowering blood pressure with active treatment vs placebo. However, if you look at the one third of patients whose systolic blood pressures were above 140 mm Hg, they actually had a significant reduction. But those whose systolic blood pressures were below 140 mm Hg had no benefit.

The cholesterol arm did show a benefit of active treatment. Rosuvastatin reduced cardiovascular events by about 25%, and we seemed to have found no lower limit.

What was interesting, however, was the 25% reduction in low-density lipoprotein cholesterol (LDL-C), or a difference of about 30 mg/dL.
In patients receiving both active treatments we saw a 25% reduction in cardiovascular events, which were attributable primarily to the amount of LDL-C reduction from the rosuvastatin.

View the HOPE-3 Trial's presentation from Salim Yusuf, Eva Lonn and Jackie Bosch (Population Health Research Insitute (PHRI), McMaster University and Hamilton Health Sciences, Hamilton, Canada.)

Learn more about the HOPE-3 Trial.