Physicians' Academy for Cardiovascular Education

Effects antihypertensive and lipid-lowering therapy on CV risk not influenced by lifestyle

Effects of Lipid-Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE3 Trial

Literature - Dagenais GR, Jung H, Lonn E et al. - J Am Heart Assoc. 2018;7: e008918. DOI: 10.1161/JAHA.118.008918

Introduction and methods

Statins and antihypertensive therapy reduce CVD risk, but it remains unknown whether this effect differs between patient with and without a healthy lifestyle. This post hoc analysis of the Heart Outcomes Prevention Evaluation (HOPE-3) trial [1-4], therefore investigated the relationship between the number of healthy lifestyle factors and the advantages of lipid-lowering and antihypertensive medication in CVD risk.

This post hoc analysis of the HOPE-3 trial investigated whether the lifestyle factors non-smoking, physical activity, optimal waist/hip ratio and healthy diet modify the effect of rosuvastatin and the antihypertensive medications candestartan/hydrochlorothiazide on CVD risk.

The double-blind, randomized, placebo-controlled HOPE-3 trial included 12,705 men ≥55 years and women ≥65 years with one CVD risk factor, or women ≥60 years with two CVD risk factors. Participants were randomly assigned to 10 mg rosuvastatin or placebo, 16/2.5 mg candestartan/hydrochlorothiazide or placebo, or the combination of rosuvastatin with candestartan/hydrochlorothiazide or placebo, and were followed for 5.6 years. The physician or nurse assessed the number of healthy lifestyle factors based on a standardized questionnaire.

The primary outcome was a composite of CVD death, non-fatal myocardial infarction, stroke, heart failure, revascularization, resuscitated cardiac arrest or ischemic angina.

Main results


Healthy lifestyle factors are associated with reduced CVD risk. The effect of statins, with or without antihypertensive therapies, on CVD risk is not affected by the extent to which participants have a healthy lifestyle. In contrast, treatment with only candestartan/hydrochlorothiazide did not have any effect on CVD risk in patients with a healthy lifestyle.


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