{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T22:53:58Z","timestamp":1754261638777,"version":"3.41.2"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,8,7]]},"abstract":"\n Background<\/jats:title>\n It is not clear whether the effects of lipid\u2010lowering or antihypertensive medications are influenced by adherence to healthy lifestyle factors. We assessed the effects of both drug interventions in subgroups by the number of healthy lifestyle factors in participants in the HOPE\u20103 (Heart Outcomes Prevention Evaluation) trial.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n In this primary prevention trial, 4 healthy lifestyle factors (nonsmoking status, physical activity, optimal body weight, and healthy diet) were recorded in 12\u00a0521 participants who were at intermediate risk of cardiovascular disease (\n CVD<\/jats:styled-content>\n ) and were randomized to rosuvastatin, candesartan\/hydrochlorothiazide, their combination, or matched placebos. Median follow\u2010up was 5.6\u00a0years. The outcome was a composite of\n CVD<\/jats:styled-content>\n events. Adjusted hazard ratios (\n HRs<\/jats:styled-content>\n ) and 95% confidence intervals (\n CIs<\/jats:styled-content>\n ) were estimated using Cox regression models. Participants with \u22652 healthy lifestyle factors had a lower rate of\n CVD<\/jats:styled-content>\n compared with those with fewer factors (\n HR:<\/jats:styled-content>\n 0.85; 95%\n CI<\/jats:styled-content>\n , 0.73\u20131.00). Rosuvastatin reduced\n CVD<\/jats:styled-content>\n events in participants with \u22652 healthy lifestyle factors (\n HR:<\/jats:styled-content>\n 0.74; 95%\n CI<\/jats:styled-content>\n , 0.62\u20130.90) and in participants with <2 factors (\n HR<\/jats:styled-content>\n : 0.79; 95%\n CI<\/jats:styled-content>\n , 0.61\u20131.01). Consistent results were observed with combination therapy (\u22652 factors:\n HR<\/jats:styled-content>\n : 0.74; 95%\n CI<\/jats:styled-content>\n , 0.57\u20130.97; <2 factors:\n HR:<\/jats:styled-content>\n 0.61; 95%\n CI<\/jats:styled-content>\n , 0.43\u20130.88). Candesartan\/hydrochlorothiazide tends to reduce\n CVD<\/jats:styled-content>\n only in participants with <2 healthy lifestyle factors (\n HR:<\/jats:styled-content>\n 0.78; 95%\n CI<\/jats:styled-content>\n , 0.61\u20131.00).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Healthy lifestyles are associated with lower\n CVD<\/jats:styled-content>\n . Rosuvastatin alone and combined with candesartan\/hydrochlorothiazide is beneficial regardless of healthy lifestyle status; however, the benefit of antihypertensive treatment appears to be limited to patients with less healthy lifestyles.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00239681.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008918","type":"journal-article","created":{"date-parts":[[2018,7,22]],"date-time":"2018-07-22T09:05:10Z","timestamp":1532250310000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of Lipid\u2010Lowering and Antihypertensive Treatments in Addition to Healthy Lifestyles in Primary Prevention: An Analysis of the HOPE\u20103 Trial"],"prefix":"10.1161","volume":"7","author":[{"given":"Gilles R.","family":"Dagenais","sequence":"first","affiliation":[{"name":"Quebec Heart and Lung University Institute Laval University Quebec City Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyejung","family":"Jung","sequence":"additional","affiliation":[{"name":"Population Health Research Institute Hamilton General Hospital McMaster University Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva","family":"Lonn","sequence":"additional","affiliation":[{"name":"Population Health Research Institute Hamilton General Hospital McMaster University Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter M.","family":"Bogaty","sequence":"additional","affiliation":[{"name":"Quebec Heart and Lung University Institute Laval University Quebec City Quebec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahshid","family":"Dehghan","sequence":"additional","affiliation":[{"name":"Population Health Research Institute Hamilton General Hospital McMaster University Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claes","family":"Held","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Cardiology Uppsala Clinical Research Center Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alvaro","family":"Avezum","sequence":"additional","affiliation":[{"name":"Dante Pazzanese Institute of Cardiology University Santo Amaro S\u00e3o Paulo Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petr","family":"Jansky","sequence":"additional","affiliation":[{"name":"University Hospital Motol Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maty\u00e0s","family":"Keltai","sequence":"additional","affiliation":[{"name":"Semmelweis University Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence A.","family":"Leiter","sequence":"additional","affiliation":[{"name":"Li Ka Shing Knowledge Institute St. Michael's Hospital and Departments of Medicine and Nutritional Sciences University of Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricio","family":"Lopez\u2010Jaramillo","sequence":"additional","affiliation":[{"name":"Research Department FOSCAL Medical School University of Santander (UDES) Bucaramanga Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William D.","family":"Toff","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences University of Leicester, and NIHR Leicester Biomedical Research Centre Leicester United Kingdom"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackie","family":"Bosch","sequence":"additional","affiliation":[{"name":"Population Health Research Institute Hamilton General Hospital McMaster University Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salim","family":"Yusuf","sequence":"additional","affiliation":[{"name":"Population Health Research Institute Hamilton General Hospital McMaster University Hamilton Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007063430103"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.292.12.1433"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17018-9"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1440"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60834-3"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1605086"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.621417"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/1010539509347941"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.112.193961"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.114.03565"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.01.001"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.07.001"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600175"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600176"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600177"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa025039"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.118.008918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T11:27:01Z","timestamp":1715599621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.118.008918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,7]]},"references-count":16,"journal-issue":{"issue":"15","published-print":{"date-parts":[[2018,8,7]]}},"alternative-id":["10.1161\/JAHA.118.008918"],"URL":"https:\/\/doi.org\/10.1161\/jaha.118.008918","relation":{},"ISSN":["2047-9980"],"issn-type":[{"type":"electronic","value":"2047-9980"}],"subject":[],"published":{"date-parts":[[2018,8,7]]},"assertion":[{"value":"2018-02-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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