盎格鲁-斯堪的那维亚心脏终点试验降脂部分（ASCOT-LLA）的分析显示，降脂和降压治疗在预防心血管事件方面具有协同效应。
英国伦敦大学帝国理工学院的Peter Sever 和他的合作者解释说，以前ASCOT降压部分（ASCOT-BPLA）的分析表明，除血压外，高密度脂蛋白（HDL）胆固醇可能减少冠心病（CHD）和中风事件。
共有19,257名高血压患者参加了ASCOT研究，随机分配到氨氯地平组或阿替洛尔组。10,305名空腹总胆固醇≤6.5 mmol （250 mg/dl）及当时未接受他汀或fibrate治疗的患者被随机分到阿托伐他汀10mg/日组或安慰剂组。平均随访3.3年以上，ASCOT-LLA的结果是阿托伐他汀可将主要终点事件（非致死性心肌梗死和致死性冠心病）的相对危险度降低36％（p<0.0001）。该结果发表在《欧洲心脏杂志》。
当前的分析是分别对每个降压治疗组进行分析，结果发现阿托伐他汀在氨氯地平组可将主要终点事件的相对危险度降低53％（p<0.0001），而在阿替洛尔组主要终点事件的相对危险度仅降低16％，无显著意义。异质性检验发现，上述风险降低的差异性处在临界值（p=0.025）。但是，两组降压人群在总体心血管事件、手术及中风的危险降低方面无显著差异。
作者称，还需进一步研究钙通道阻滞剂和他汀类药物之间相互作用的合理分子机制，从而解释其稳定动脉粥样硬化斑块，影响CHD事件发生的效应。
study suggests synergistic lipid- and BP-lowering effects
19 December 2006
Analysis of the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm (ASCOT-LLA) suggests that lipid-lowering and blood pressure (BP)-lowering regimens have synergistic effects in preventing cardiovascular events.
Previous analyses of the ASCOT BP Lowering Arm (ASCOT-BPLA) suggested that factors other than BP, particularly high-density lipoprotein (HDL) cholesterol, may have contributed to the reductions in coronary heart disease (CHD) and stroke events observed in the trial, explain Peter Sever (Imperial College London, UK) and co-investigators.
Noting that additional mechanisms could also be involved, the researchers investigated whether potential interactions between the antihypertensive and lipid-lowering regimens could have affected the ASCOT-BPLA findings, in a prespecified analysis of ASCOT-LLA.
Of the total 19,257 hypertensive patients participating in ASCOT who were randomly assigned to receive an amlodipine-based regimen or an atenolol-based regimen, 10,305 patients who had a fasting total cholesterol level ≤6.5 mmol (250 mg/dl) and were currently untreated with a statin or fibrate were also randomly assigned to receive either atorvastin 10 mg daily or placebo in ASCOT-LLA.
Over a median follow-up of 3.3 years, the main result of ASCOT-LLA was that atorvastatin reduced the relative risk of the primary endpoint of nonfatal myocardial infarction and fatal CHD events by 36% (p<0.0001), the authors note in the European Heart Journal.
The current analysis, taking each antihypertensive group separately, revealed that atorvastatin reduced the relative risk of the primary endpoint by 53% (p<0.0001) in the amlodipine group, whereas the risk of this outcome was reduced nonsignificantly, by just 16%, among those on atenolol.
Testing for heterogeneity indicated that the difference between these risk reductions was of borderline significance (p=0.025).
Differences between antihypertensive groups in the risk reductions for total cardiovascular events and procedures and stroke were not significant, however.
The authors say that their findings warrant further study, noting that there are "plausible" molecular explanations for an interaction between calcium channel blockers and statins, which could lead to atherosclerotic plaque stabilization and thereby account for the differential effect specifically on CHD events.
Eur Heart J 2006; 27: 2982-2988
http://www.incirculation.net/NewsItem/ASCOT-study-suggests-synergistic-lipid-and-BPlower-784788.aspx
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