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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EPrior treatment with atorvastatin is associated with a reduction in the risk of all-cause mortality compared with placebo 8 years after the early termination of the Anglo-Scandinavian Cardiac Outcomes Trial\u2014Lipid-Lowering Arm [ASCOT-LLA] and 11 years after initial randomization, according to new findings from a long-term follow-up study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPrior treatment with atorvastatin is associated with a reduction in the risk of all-cause mortality compared with placebo 8 years after the early termination of the Anglo-Scandinavian Cardiac Outcomes Trial\u2014Lipid-Lowering Arm (ASCOT-LLA) and 11 years after initial randomization, according to new findings from a long-term follow-up study.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn 2003, an interim analysis of ASCOT-LLA showed that atorvastatin significantly reduced the risk of coronary heart disease (CHD; RRR 36%) and stroke (RRR 27%) compared with placebo in patients with hypertension who were also receiving antihypertensive treatment, leading to an early termination of the trial [Sever PS et al. \u003Cem\u003ELancet\u003C\/em\u003E 2003]. The subgroup of patients who were enrolled in the United Kingdom (UK) cohort of ASCOT-LLA was then followed for an additional 8 years after trial termination on open-label therapy, as selected by the local health care provider. Peter S. Server, MD, FRCP, Imperial College, London, UK, presented mortality results for the entire 11-year follow-up period since initial randomization in ASCOT-LLA.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EIn the ASCOT-LLA randomized trial, 10,305 patients with hypertension and a total cholesterol level of \u22646.5 mmol\/L (250 mg\/dL) were randomly assigned to atorvastatin 10 mg or placebo. After a median follow-up of 3.3 years, the trial was terminated due to overwhelming benefit with atorvastatin, with a reduction in the primary endpoint of nonfatal myocardial infarction (MI) and fatal CHD of 36% compared with placebo (HR, 0.64; 95% CI, 0.50 to 0.83; p=0.0005). At that time, there was no significant difference between groups in terms of either all-cause mortality (HR, 0.87; 95% CI, 0.71 to 1.06) or cardiovascular (CV) mortality (HR, 0.90; 95% CI, 0.66 to 1.23).\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAfter ASCOT-LLA was terminated, investigators continued to collect mortality data in the UK cohort (n=4605) for a total median follow-up of 11 years from initial randomization. Mortality data were available from the UK Office for National Statistics and General Register Office for Scotland, and the cause of death was identified in death certificates.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EBy the end of the ASCOT-LLA extension study, most patients who were initially randomized to atorvastatin therapy continued to take atorvastatin (63%), while a minority (4%) took another statin. Likewise, most patients in the placebo group also switched to atorvastatin (56%), with a small number initiating therapy with another statin (7%).\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThrough 11 years of median follow-up in the ASCOT-LLA extension group, the risk of all-cause mortality was 14% lower for those who were initially assigned to atorvastatin compared with placebo (HR, 0.86; 95% CI, 0.76 to 0.98; p=0.02). The survival benefit was driven by a reduction in non-CV deaths (HR, 0.85; 95% CI, 0.73 to 0.99; p=0.03). In particular, patients who were initially randomized to atorvastatin had a lower long-term risk of death due to infections and respiratory illness (HR, 0.64; 95% CI, 0.42 to 0.97; p=0.04; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). By comparison, there was no difference in the risk of death due to CV causes (HR, 0.89; 95% CI, 0.72 to 1.11; p=0.32).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Cumulative Incidence of Mortality Due to Combined Infection and Respiratory Disease.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-612362222\u0022 data-figure-caption=\u0022Cumulative Incidence of Mortality Due to Combined Infection and Respiratory Disease.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/10\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12446\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ECumulative Incidence of Mortality Due to Combined Infection and Respiratory Disease.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from Oxford University Press. The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the UK. Sever PS et al. \u003Cem\u003EEur Heart J. 28 Aug\u003C\/em\u003E 2011.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EThese observations from the ASCOT-LLA extension study may suggest a legacy benefit in terms of a reduction in mortality with atorvastatin, further underscoring the benefit of statins. The mechanism by which statin therapy may reduce the risk of infection and non-CV death over the long term is unclear and needs verification in additional studies, given the limitations of this nonrandomized comparison. Future prospective studies may determine if statins can reduce the risk of sepsis or death from infectious illness, Prof. Sever concluded.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2 class=\u0022\u0022\u003EAdditional Reading\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label ref-label-empty\u0022\u003E\u003C\/span\u003E\n            \u003Cdiv class=\u0022cit ref-cit ref-journal no-rev-xref\u0022 id=\u0022cit-11.10.22.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESever\u003C\/span\u003E  \u003Cspan class=\u0022cit-name-given-names\u0022\u003EPS\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EEur Heart J\u003C\/abbr\u003E \n               \u003Cspan class=\u0022cit-pub-date\u0022\u003E2011\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/10\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmz01\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmz01\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}