In a large cohort of intermediate risk patients with no known CAD, treatment with low doses of statins in addition to an angiotensin receptor blocker and a diuretic, reduce the risk of cardiovascular events, compared to placebo.

These are the main findings of the HOPE 3 trial (Heart Outcomes Prevention Evaluation) that randomized 12705 patients, and was presented at the scientific sessions of the American College of Cardiology 2016, and simultaneously published in NEJM.

The study formally tested the concept of“polypill” and its potential effects on hard cardiovascular events.

Patients were randomized in a 2 x 2 factorial design, showing that the combination ofrosuvastatin 10 mg, candesartan 16 mg, and hydrochlorothiazide 12.5 mg per day, results in a complete reduction of the1.4% risk, compared to placebo, in a median follow up period of 5.6 years.

The benefit of this treatment was largely associated with a reduction of LDL levels. When analyzed separately, the use of rosuvastatin resulted in an approximately 25% reduction, compared to placebo, while candesartan and hydrochlorothiazide had no significant impact.

The benefits of lowering blood pressure are obvious only in patients with higher systolic blood pressure. For hypertensives, the benefit is a 40% reduction in events rate, where half the benefit is due to statins and the other half due to antihypertensives.

In patients with systolic blood pressure of 143.5 mmHg or lower, the benefit was derived exclusively from statins and even in those with systolic blood pressure of 131.5 mmHg or lower, antihypertensives could be prejudicial.