Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up
Main finding · Non-fatal MI and fatal CHD eventsResult — go to the resultHazard ratio 0.81 95% CI 0.69–0.94Authors' conclusion
These observations provide further evidence for the long-term legacy effects of statins and have implications for the early introduction of statins to prevent CV events and mortality.
Study context
- Population
- UK hypertensive participants with total cholesterol <6.5 mmol/Lfollowed for up to 21 years (IQR 9.1–19.3)
- Participants
- 4,605 participants
- Exposure
- Atorvastatin vs placebo
- Atorvastatinn = 2,317
- Placebon = 2,288reference
- Outcome
- Non-fatal MI and fatal CHD events
Methodological details20-year follow-up of the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm, Cox proportional hazard models
- 20-year follow-up of the Anglo-Scandinavian Cardiac Outcomes Trial-lipid-lowering arm
- Cox proportional hazard models
Main finding
As reported in the abstract
Hazard ratio
0.81
95% CI 0.69–0.94
P = 0.006
Atorvastatinvs placebo
HR 0.81 (95% CI 0.69–0.94); P = 0.006
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Total coronary events | 0.88 (0.80–0.98) | P = 0.017 | |
| CV deaths | 0.86 (0.74–0.99) | P = 0.048 | |
| 0.512Hazard ratio (log scale) |
Heart failure (HF), strokes, total cardiovascular (CV) events and all-cause mortality
- No significant reduction in heart failure (HF), strokes, total CV events and all-cause mortality
Long-term CV outcomes per 1 mmol/L decrease in 3-year mean LDL-cholesterol (participants assigned atorvastatin)
- Non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD) HR
- 0.69 (0.57 to 0.85, p<0.001)
- Total coronary events HR
- 0.70 (0.61 to 0.79, p<0.001)
- Non-fatal and fatal HF HR
- 0.68 (0.57 to 0.81, p<0.001)
- Non-fatal and fatal stroke HR
- 0.74 (0.59 to 0.92, p=0.006)
- Total CV events and procedures HR
- 0.74 (0.66 to 0.81, p<0.001)
- CV mortality HR
- 0.66 (0.55 to 0.81, p<0.001)
- All-cause mortality HR
- 0.81 (0.71 to 0.90, p<0.001)
- HRs per 1 mmol/L decrease
Post-trial atorvastatin use and lipid profiles · 2 years and ≈9 years post-trial
- Two years after the trial, approximately two-thirds of subjects in each arm were taking atorvastatin
- Lipid profiles were similar between those formerly assigned atorvastatin or placebo
- At the end of the original trial (3.3 years), all participants were offered atorvastatin
Original publication
Long-term benefits of atorvastatin on the incidence of cardiovascular events: the ASCOT-Legacy 20-year follow-up. Heart. Published 26 March 2025. doi:10.
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