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Cardiovascular diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause.1 The incidence of CVD rises progressively with increasing blood pressure (BP) and with increasing levels of total and low density lipoprotein (LDL) cholesterol. Pharmacological treatment of BP with several classes of drugs and of lipids with HMG-CoA reductase inhibitors (statins) have been demonstrated to reduce the incidence of CVD.2 ,3 Antihypertensive trials have predominantly enrolled individuals at specific BP levels and titrated medications to achieve either a specific target BP or a specific decrease in BP. In contrast, lipid trials have enrolled individuals at increased risk for CVD, most commonly with increased LDL, and treated with a fixed dose of a statin with no specific target. A major clinical question remains inadequately answered with existing evidence: who should be treated with medications for BP or lipids for primary prevention of CVD?
The Heart Outcomes Prevention Evaluation (HOPE)-3 trial was a double-blind, randomised, placebo-controlled trial (RCT) at 228 centres in 21 countries, using a 2×2 factorial design. The trial included men aged ≥55 years and women aged ≥65 years without CVD who had at least one of the following CVD risk factors: elevated waist-to-hip ratio, history of low concentration of high density lipoprotein (HDL) cholesterol, tobacco use, dysglycaemia, family history of premature coronary artery disease, …
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