Stroke Risk Nearly Halved by Some Combinations of Medications to Lower Blood Pressure and Cholesterol

The data here gives a fairly good idea of the bounds of the possible and plausible when lowering blood pressure and blood cholesterol, putting some numbers to the degree to which stroke risk can be reduced. Strokes occur due to breakage or blockage of blood vessels, and the roots of that lie in (a) the stiffening of blood vessels that breaks the feedback mechanisms determining blood pressure, and (b) the processes of atherosclerosis that produce fatty plaques in blood vessel walls, narrowing and weakening them.

Blood pressure medications don't address the roots of the problem, but force a lower blood pressure, which reduces the risk of rupture in weakened vessels. Lowered blood cholesterol, such as via statins, or more modern and effective approaches such as PCSK9 inhibition, reduces the pace at which atherosclerosis progresses over time by reducing the amount of damaged cholesterol in the blood stream. Again, it achieves this result not by addressing the root causes of that damage, but through a blanket lowering that happens to include the problem cholesterol molecules that feed the growth of atherosclerotic plaques. Fortunately it appears that we humans don't need anywhere as much cholesterol as we have; it is interesting to speculate on why we seem to have at least ten times as much in our bloodstreams as we need to get by.

Combining medication that lowers blood pressure with medication that lowers cholesterol reduced first-time strokes by 44 percent. Seventy-five percent of strokes are first-time strokes. High blood pressure and high cholesterol both increase the risk for stroke, the fifth leading cause of death in America. Yet it's not known whether combining drugs that lower blood pressure and cholesterol levels can protect individuals from stroke. Now, a study involving 12,705 participants from 21 countries shows that individually, drugs that lower blood pressure or cholesterol do indeed reduce stroke risk, but when combined, they offer even greater protection.

Taking daily doses of two blood pressure drugs (fixed dose candesartan and hydrochlorothiazide) along with a cholesterol-lowering drug (low-dose rosuvastatin), proved to be the most effective, cutting first-time strokes by 44 percent among patients at intermediate risk for heart disease. For those with very high blood pressure - readings 143.5 mm Hg or higher - taking 16 milligrams of candesartan plus 12.5 milligrams of hydrochlorothiazide every day reduced stroke by 42 percent. Compared with a placebo, stroke was reduced by 30 percent among participants taking daily doses of 10 milligrams of rosuvastatin.

The findings come from the Heart Outcomes Prevention Evaluation Study, a large, international study focused on heart disease and stroke prevention. The average age of the participants was 66 years; 46 percent were women, and 166 strokes occurred during an average follow-up of 5.6 years. At the start of the study, the average blood pressure was 138/82 mm Hg. A normal blood pressure reading is around 120/80 mm Hg. Based on these findings, researchers are now looking at developing a single pill that produces the same effects as taking multiple pills that lower both blood pressure and cholesterol.

Link: https://newsroom.heart.org/news/combining-drugs-that-lower-blood-pressure-and-cholesterol-could-do-more-to-prevent-stroke

Comments

I often feel disappointed by some medical organizatins, who are noe pushing terms as "overtreatment", "unnecessary care" etc. in metabolic disorders, such as hypertensiom and diabetes, by a practice called "deprescribing", denying access to these drugs. What they don't seem to get is that combining drugs can have excellent outcomes. There is a thing in biology and pharmacology called synergy.

Posted by: Matheus at January 26th, 2018 2:21 PM

@Matheus: You are correct.

(A) Im a heart transplant recipient from age 15. From that time I have used Pravachol 40 mg pr day prescribed by my doctor. My friends at my same age says Im looking younger than them. Im you search for statins you will see that it was discovered a pleiotropic effect a few years ago. It wee shown to lengthen telomeres and lengthen life because you dont get that fat in your arteries.

(B) My cardiologist who are an expert in heart transplants said to me at age around 55: "Im nearing age 60 and I have thought about "prescribe" statins for myself.

(C) At SeekingAlpha I wrote with DoctoRx. He wrote that when statins were new in early 90-ies he prescribed it for his patients. However his colleagues were more cautious. He soon learned that his patients lived for longer.

(D) It is my opinion that everyone should get statins from day one after birth. My mother gave me multivitamins and Omega 3. Dr. David Sinclair gives resveratrol to his children.

Posted by: Norse at January 26th, 2018 4:32 PM

Hi, just a 2 cent.

''Fortunately it appears that we humans don't need anywhere as much cholesterol as we have; it is interesting to speculate on why we seem to have at least ten times as much in our bloodstreams as we need to get by.''

I think it is due to cholesterol acting as a fluidizer, and why higher cholesterol fluidizes mitochondrial membranes (improve mitochondrial kinetics by more fluid membrane). I am also guessing that excess cholesterol is not so bad after all, depending on which kind though. The body needs a specific HDL:LDL ratio, when you have atherosclerosis and survived it (as I have it, and survived it, (because I'm talking right now, still alive, though I still suffer from intense verystabbing-ischemia some times in low O2 places)), your levels change towards a very high LDL content/vLDL this makes the HDL:LDL ratio low (more LDL per HDL) and that is fatal (causing the LDL to signal macrophage uptake in atherolesion as the LDL filled plaques grow/clog in artery tissue lesions). The brain is cholesterol rich and the explanation for such, is mainly down to fluidizing property of cholesterol in mitochondria IMM. Between 2-3 fatty acids are cholesterol molecule 'inserted' between these fatty acids and cholesterol; cholesterol acts akin to highly polyunsaturated Omega-3s, DHA/EPA, especially; both greatly fluidize membrane and why - there are so rich in the brain mitochondrial phospholipids : i.e. the brain needs 'to think/fast' and fast is only gotten with fluidizer of the mitochondrial membrane (that is why there is less saturated fatty acids/viscous fatty acids in brain (viscosity that 'Slows down membrane kinetic', think like 'waxy' fatty acids they are 'solid' and reduce fluidizing 'watery' effect/slow down membrane movement for better 'solidification', but a slow membrane 'is slow' as such not fast enough for ATP production and conduction, and 'brain tasks - like thinking') then O-3s long-chain polyunsaturates or cholesterol molecules). We must not ask ourselves why these polyunsaturates have healthy benefits, the activate genes which are anti-inflammatory and as said, accelerate the metabolism/ATP throuput through improved fluidization of mitomembrane (like in atherosclerosis, they reduce plaque size, such linolenic acid (Gammalinolenic acid 18:3) found in flaxseed oïl; and in several rabbit atherosclerosis studies when they fed them such fatty acids there was a reduction of arterial LDL-cholesteric fatty plaques.). But care should be taken with Omega-3, they should be in 'natural' form not the supplement type - they are often rancid/oxidized and with capsules, the Omega-3 fish oïl contains Cholesterol on top of that (they never say it on the bottle, you are getting Omega-3 (and your point is to Reduce cholesterol LDL) but you are Consuming Cholesterol the minute you take these O3 capsule; thus self-defeating. This is akin to eating full fish, full fish is bette of course for it contains O3s, but it contains a - Hefty dose of Cholesterol (and it's why I completely stopped eating fish (and it saved me doing that, for ANY cholesterol you take If you have Atherosclerosis is Deadly) when I had first 'late-stage' atherosclerosis now more than 2 years ago - and I'm still here to talk about it and my LDL levels obviously dropped or else I would be dead).

The point is you don't want to reduce cholesterol - You Need It - what you want is to Change the Ratio of HDL to LDL (HDL:LDL), too little Total Cholesterol is just as bad; it's why cholesterol-reducing therapy can be Deadly - Despite reducing Cholesterol - You Need It - just the Right Amount and in the Right Ratio, and when you have Atherosclerosis you Reduce your levels you have Too Much - Way Too Much and it is 1st Contributor of your death; Hence, why I COmpletely Stopped Eating Anything containing cholesterol, in fact I have not consumed a single cholesterol food for over 2 years (0mg cholesterol food so far) and I am still here.

With that said, as specified you need cholesterol (thus not eating Any cholesterol containing foods Seriously reduces the capacity of body to make/intake cholesterol because there is none anymore; the liver must fabricate it with very little and the output is thus reduced. Even so, that was Still not enough, not only must you stop eating these cholesterol-ladden foods you must reduce your Current cholesterol levels; thus it's combination of Stopping Eating Cholesterol Foods + Eating Foods that Reduce Cholesterol Already There/Foods that reorder your HDL:LDL ratio/Foods that are capable of altering the enzymatic LDL-cholesterol species production that is, to let much more HDL species be produced Over the LDL species; and it is feasible and it is also why, reducing BOTH HDL and LDL is Very BAD; you do not want to remove it all you only want to reduce the LDL and increase the HDL, or at least that it maintains and does not reduce so that the HDL:LDL ratio is now High (I.e. High HDL for LDL))). Centenarians whom lived extreme lifespans all display this, high HDL:LDL ratios. HDL is capable of mopping ROS and activâtes a pletheroa of genes APOlipoprotein that are Anti-Inflammatory and also command the monocytes/macrophage 'inflammatory response' to reduce; so there is not inflammatory infiltration like it happens in atherosclerosis. Inflammation (immune system/macrophage/TNF/IL-6...) causes this plaque growth in a vicious circle of 'auto-damaging/auto-lesions' formation) as the macrophage die in futile attempt at the lesion site and produce senescent endothelial cells (that produce ROS/SASP)/ischemia/LDL plaque filling.

Just a 2 cent.

Posted by: CANanonymity at January 26th, 2018 9:27 PM

PS: statins are ok, but be careful with them too for there are sideeffects, substantial ones. I believe there is more good to taking them than not; I mostly mean if you are diseased and have CVD/atherosclerosis; otherwise I'm not sure they are warranted if you are healthy (and had your level checked/all is ok and your arterial fatty plaques are small/don't have any). I have two members of family taking statins and clearly, it helped them and did reduce LDL levels; they work by blocking Liver-X receptor, simply there it blocks 'total cholesterol uptake and production' in liver. I did not take one single statins and I'm still there; thus, it is a diet change that is needed and multivitamin is definately helpful. I have foudn that the single most powerful LDL-cholesterol reducer is Vitamin D3 cholacalciferol (more powerful than statins, fiber intake, phytosterols like Betasitosterol/Campferol (plant analogs of cholesterol that hinder it)). The reason is beacause the Vitamin D is behind the entire LDL/HDL cascade and Controls it; thus why you see dramatic changes in LDL levels with D3 intake. D3 alters the liver enzymes toward HDL species production over LDL species. Not only that, D3 increase ATP in cells (this an immediate effect when exposed to UV rays in skin cells that produce natural D3).

Posted by: CANanonymity at January 26th, 2018 10:09 PM

Im a healthy 32 year old this year and a vegan taking pravachol (pravastatin) 40 mg every day for 16 years without any side effect.

Posted by: Norse at January 27th, 2018 6:35 AM

I also have to add that I had normal cholesterol levels when my doctor prescribed statins. My father had a high/elevated cholesterol level in late 90-ies then he read that drinking green tea reduced levels, he drank 1 cup every day and within 3 months he had normal. Today he is still overweight and I guess his levels are too high but his doctor wouldn't prescribe. I think we as a society are to conservative when it comes to using statins and other geroprotectors. I take resveratrol and l-carnosine. Until last year I took alpha-lipoid acid shipped to me from Biovea. However, then Norway came with import restriction on that geroprotector and have labelled it as illegal.

Posted by: Norse at January 27th, 2018 6:48 AM

Someone here who knows how I can get alpha-lipoid acid?

Posted by: Norse at January 27th, 2018 6:49 AM

@CANonymity: When it comes to side effects and risks taking statins Im sure there are far more risks taking Metformin.

Posted by: Norse at January 27th, 2018 6:51 AM

Hi Norse ! Thanks for that. Just a 2 cent.

It's ironic because your father took statins (without side effects) and my father took metformin (for his diabetes type II, without side effects so far; well, I mean, the only side effect is just that he is aging and metformin 'does what it can' and his glucose is maintained but with age, it rises as the beta-cells in the pancreas are not functionning as well and visceral fat mass accumulation surrounds the pancreas, suffocating it).

If you had not side effects, demonstrates that not everyone responds the same; it's really the dillema with any medical product, not one person reacts Exactly the same. THere is a large group of people that have about the same effect; but there are almost always a few outliers or 'non-responders'; or we could even call them 'different-responding responders'.

I know that with most anything there is Good and Bad that comes with it, and you have to weigh the risks. And since it did work for your father, I can fully understand why you took it and things are good for you too.

Perhaps, if I take metformin, it will work like it did for my father; but, I prefer not to. Since, as you said, there are some side effects. And one study found that (ironically ?) metformin accelerated aggregation of proteins in mice's brain (kind of like accelerated beta-amyloid formation; when the whole point of metformin is to slow that and it does, because it slows diabete type II by regulating blood glucose; and blood glucose is Causal to Alzheimer's (alzheimer's is called diabetes type III 3); glycation/glycoxidation accelerates brain ALz onset and brain tissue destruction. Thus, if you slow it, which metformin does, then you do slow that; but the study showed that there were Side Effects to meformin, and it pertubed the brain protein system towards protein aggregation; at least in certain mice that is.

Statins negative side effects: they may actually be things worse in certain cases or certain people. At least, not in your case and your father's becaus taking statin. But not all respond the same because our cholesterol mechanisms differ. For example, I suffer from French Canadian ancestral (to France backtracked) mutation that creates extreme cholesterol levels of LDL uptake and production - yet I'm thin - 130 lbs/no belly whatsoever, some would think-meager just a bit muscle, and your father you say was/is heavy;;and lives a very long life; demonstrating that it is not so much fat the problem it's internal fat/visceral fat surrouding organs/white/Brown adipose tissue control; my father is younger and had beer belly, not anymore; your father might be heavier yet he lived this long; statins obviously helpedh im to reduce his LDL as it did for 2 family members of mine; they have no problems on statins and it works for them (and they suffer also from French Canadian hypercholesteremia mutation). Your family may suffer from Norwegian/Scandinavian mutation (if you are ancestrally/ethnically so) that affects the cholesterol levels. I also know that fish & seafood/lobster... is Very Popular in scandinavia because of Fishing/Mariners importat part of ancient history, I use to eat Sardines day in and out...

All I'm saying if all is well, there is no problem for statins.

Just a 2 cent.

PS:

Here are 'true or untrue?' articles talking about certain side effects:

Statin Adverse Effects: A Review of the Literature and Evidence for a Mitochondrial Mechanism
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849981/

2. https://articles.mercola.com/sites/articles/archive/2010/07/20/the-truth-about-statin-drugs-revealed.aspx

3. https://articles.mercola.com/sites/articles/archive/2016/02/10/5-reasons-why-you-should-not-take-statins.aspx

4. https://www.healthline.com/health/high-cholesterol/statins-list-of-common-types

Posted by: CANanonymity at January 27th, 2018 5:35 PM

Another area were it would be nice if someone somewhere would produce a bicyclic peptide instead of a big pharma costly antibody, this time to PCSK9.

The antibodies to PCSK9 produced by big pharma seem to work well without side effects like Statins, but they will cost thousands until they are off patent over a decade from now.

Posted by: Jim at January 28th, 2018 12:49 AM

Post a comment; thoughtful, considered opinions are valued. Comments incorporating ad hominem attacks, advertising, and other forms of inappropriate behavior are likely to be deleted.

Note that there is a comment feed for those who like to keep up with conversations.