Ethnic variations in lipid-lowering in response to a statin (EVIREST): a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)

Abstract

Background: Statins improve lipid profiles and reduce cardiovascular morbidity and mortality but there are few data on their relative effects in different ethnic groups.

Methods: We used data from the randomised, placebo-controlled Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA) to conduct a prespecified comparison of the lipid-lowering efficacy of statin therapy among hypertensive participants from different ethnic groups in the UK and Ireland. The effects of atorvastatin (10 mg daily) and placebo on fasting plasma lipid profiles were compared in matched groups of Whites and Blacks (of African-Caribbean or African origin) and Whites and South Asians (from the Indian subcontinent), adjusting for placebo effect.

Results: In the active treatment group, 156 Blacks and 72 South Asians were compared with 419 and 198 Whites, respectively. In multivariable analyses adjusted for baseline lipid levels and other potential confounders, atorvastatin reduced total cholesterol, low-density lipoprotein (LDL)-cholesterol and triglycerides from baseline in all ethnic groups. There were no clinically or statistically significant differences in the effect between Whites and Blacks or between Whites and South Asians after adjusting for placebo effect; similar proportions in each group achieved lipid targets. There was no significant effect of atorvastatin on high-density lipoprotein (HDL)-cholesterol in any group.

Conclusions: A standard dose of atorvastatin improved lipid profiles to a similar extent in Whites, Blacks and South Asians. Given the proven benefits of statins, these results suggest that, when used in standard doses, they are likely to be similarly effective for cardiovascular disease prevention in all ethnic groups.