Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study.

Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study.

MedLine Citation:	PMID: 19103995 Owner: NLM Status: MEDLINE
Abstract/OtherAbstract:	BACKGROUND: Statins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. METHODS AND RESULTS: CAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure-lowering treatment strategy in the factorial design. CONCLUSIONS: Statin therapy sufficient to significantly reduce cardiovascular events in treated hypertensive patients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT patients in CAFE-LLA.

Authors:	Bryan Williams; Peter S Lacy; J Kennedy Cruickshank; David Collier; Alun D Hughes; Alice Stanton; Simon Thom; Herbert Thurston;
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Publication Detail:	Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2008-12-22
Journal Detail:	Title: Circulation Volume: 119 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Jan
Date Detail:	Created Date: 2009-01-06 Completed Date: 2009-02-06 Revised Date: -
Medline Journal Info:	Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States
Other Details:	Languages: eng Pagination: 53-61 Citation Subset: AIM; IM
Affiliation:	Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK. bw17@le.ac.uk
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MeSH Terms
Descriptor/Qualifier:	Aorta / physiology* Blood Pressure / drug effects* Brachial Artery / physiology Cholesterol, LDL / blood Female Heptanoic Acids / administration & dosage* Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage* Hyperlipidemias / drug therapy, physiopathology Hypertension / drug therapy, physiopathology Male Middle Aged Placebos Pulsatile Flow / drug effects Pyrroles / administration & dosage* Radial Artery / physiology Treatment Outcome
Chemical
Reg. No./Substance:	0/Cholesterol, LDL; 0/Heptanoic Acids; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Placebos; 0/Pyrroles; 110862-48-1/atorvastatin
Investigator
Investigator/Affiliation:	B Williams / ; P S Lacy / ; H Thurston / ; D O'Brien / ; P Swales / ; S Nanayakkara / ; A Stanley / ; K Edwards / ; W Gamble / ; V Garratt / ; J Harris / ; A Kirkham / ; Y Revell-Smith / ; L Bernhardt / ; S Thom / ; A Whitehouse / ; A D Hughes / ; J Macduff / ; S Leech / ; L Kinsley / ; O Trainor / ; Y Chim / ; A Jack / ; S Murphy / ; R Baruah / ; F Harrison / ; R Fernandez / ; A Strain / ; M Liboro / ; A Stanton / ; E O'Brien / ; E Dolan / ; D Farrell / ; O B Gallagher / ; S Lyons / ; G McCarthy / ; K Cruickshank / ; S Dean / ; J Dunkerley / ; M Banerjee / ; M Holland / ; M Hart / ; M Cullen / ; L Hardstaff / ; J Reynolds / ; J Collins / ; K Peters / ; M Luckson / ; D Collier / ; M Caulfield / ; C Waleczko / ; G Salahi-Ali / ; J Sheil / ; B Scott / ; S Wilson / ; C David / ; H Fok /
Comments/Corrections
Comment In:	Circulation. 2009 Jan 6;119(1):9-12 [PMID: 19103984 ]

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