Evidence map›Statins × blood pressure›PMID 19103995›Full record

Trial reportCirculation2009

Impact of statin therapy on central aortic pressures and hemodynamics: principal results of the Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) Study.

Bryan Williams, Peter S Lacy, J Kennedy Cruickshank, David Collier, Alun D Hughes, Alice Stanton, Simon Thom, Herbert Thurston, CAFE and ASCOT Investigators

Abstract readMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Circulation, 2009. The graph read 7 numbers from its abstract, feeding 4 cells of the map: it supports the treatment in 1, finds no clear difference in 3. Cited by 31 papers, 3 of them syntheses that pooled it.

7numbers the graph read from it
4cells of the map it votes in
31citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
-36.31.800 · no effect
Blood pressureno clear difference · against placebo · dyslipidemia, hypertensionfeeds one cell of the map
change -0.10-1.80 to 1.60P=0.9
Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9).
FeedsStatins×blood pressure
Cardiac & vascular functionno clear difference · against placebo · dyslipidemia, hypertensionfeeds one cell of the map
change -0.50-2.30 to 1.20P=0.5
Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo.
FeedsStatins×cardiac & vascular function
Blood pressure · Cardiac & vascular function · Adverse events & safetyno clear difference · against placebo · dyslipidemia, hypertensionfeeds 3 cells of the map
change -0.40-1.70 to 0.80P=0.5
Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo.
FeedsStatins×blood pressureStatins×cardiac & vascular functionStatins×adverse events & safety
Blood pressure · Cardiac & vascular functionno clear difference · against placebo · dyslipidemia, hypertensionfeeds 2 cells of the map
change -0.40-1.90 to 1.00P=0.6
Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo.
FeedsStatins×blood pressureStatins×cardiac & vascular function
Blood pressureno clear difference · against placebo · dyslipidemia, hypertensionfeeds one cell of the map
change -0.02-1.60 to 1.60P=0.9
Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9).
FeedsStatins×blood pressure
Cardiac & vascular functionno clear difference · against placebo · dyslipidemia, hypertensionfeeds one cell of the map
change 0.25-1.30 to 1.80P=0.7
Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo.
FeedsStatins×cardiac & vascular function
Lipidsfavours the treatment · against placebo · dyslipidemia, hypertensionfeeds one cell of the map
lowered -32.4-36.3 to -28.6
Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo.
FeedsStatins×lipids

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Statins×blood pressure

InconclusiveOpen on the map →What to test next →

9 readable studies in this cell: 4 favour the treatment, 4 find no difference, 1 favour the comparator.

Belief with this paper
0.83replicated · 5 families support, 1 contradict · against placebo
Without it
0.83This paper does not move the number.
← favours the treatmentfavours the comparator →
0 · no effect
This paper · 2009
change -0.10-1.80 to 1.60
Effect of fixed dose combination treatment on adherence and risk facto…PMID 24868083 · 2014
lowering -59.0
The effects of statins on blood pressure in normotensive or hypertensi…PMID 23602289 · 2013
Δ 1.45-0.49 to 3.39
Effects of adding prescription omega-3 acid ethyl esters to simvastati…PMID 18678300 · 2008
Δ -3.30

Statins×cardiac & vascular function

InconclusiveOpen on the map →What to test next →

11 readable studies in this cell: 4 favour the treatment, 6 find no difference, 1 favour the comparator.

Belief with this paper
0.50contested · 3 families support, 3 contradict · against placebo
Without it
0.50This paper does not move the number.
← favours the treatmentfavours the comparator →
0 · no effect
This paper · 2009
change -0.50-2.30 to 1.20
NCT023442907,769 enrolled · 2015
Δ -4.30-8.60 to -0.10
NCT02546323543 enrolled · 2015
Δ -0.01-0.02 to -0.00
NCT00728988499 enrolled · 2008
Δ 4.90-6.20 to 15.9
NCT0181335784 enrolled · 2013
Δ 0.00
Effect of rosuvastatin on progression of carotid intima-media thicknes…PMID 17384434 · 2007
change 0.00-0.00 to 0.00
Effect of Targeting Inflammation With Salsalate: The TINSAL-CVD Random…PMID 27438317 · 2016
Δ -1.00-11.0 to 9.00
Atorvastatin improves left ventricular systolic function and serum mar…PMID 16412856 · 2006
increase 0.04
Simvastatin combined with ramipril treatment in hypercholesterolemic p…PMID 15184351 · 2004
reduced -7.00

Statins×adverse events & safety

InconclusiveOpen on the map →What to test next →

11 readable studies in this cell: 3 favour the treatment, 7 find no difference, 1 favour the comparator.

Belief with this paper
0.16contested · 1 family supports, 4 contradict · against placebo
Without it
0.16This paper does not move the number.
← favours the comparatorfavours the treatment →
0 · no effect
This paper · 2009
change -0.40-1.70 to 0.80
NCT002899002,340 enrolled · 2006
Δ 13.79.40 to 18.0
NCT01294683977 enrolled · 2011
Δ -1.03-7.30 to 5.25
NCT00728988499 enrolled · 2008
Δ 1.00-7.30 to 9.30
NCT01678820299 enrolled · 2012
Δ -0.40-10.2 to 9.30
A retrospective analysis of the effect of noncompliance on time to fir…PMID 14604742 · 2003
RR 2.27
Dyslipidemia in chronic kidney disease: randomized controlled trial of…PMID 25079861 · 2014
Δ -37.4

Statins×lipids

SupportsOpen on the map →What to test next →

38 readable studies in this cell: 28 favour the treatment, 4 find no difference, 6 favour the comparator.

Belief with this paper
0.50contested · 21 families support, 7 contradict · against placebo
Without it
0.50This paper does not move the number.
← favours the treatmentfavours the comparator →
0 · no effect
This paper · 2009
lowered -32.4-36.3 to -28.6
NCT002899002,340 enrolled · 2006
Δ -13.2-16.8 to -9.60
Effect of evolocumab or ezetimibe added to moderate- or high-intensity…PMID 24825642 · 2,067 enrolled · 2013
reduced -66.0-73.0 to -58.0
NCT02546323543 enrolled · 2015
Δ -35.5-40.2 to -30.7
NCT01678820299 enrolled · 2012
Δ 0.50-4.80 to 5.80
NCT01218204287 enrolled · 2010
Δ 5.47-15.7 to 26.7
Lipid-Lowering Effect and Safety of Ezetimibe and Atorvastatin 5 mg in…PMID 40357888 · 252 enrolled · 2022
Δ -47.6
NCT0093525931 enrolled · 2009
Δ -51.7
Effect of Patient Financial Incentives on Statin Adherence and Lipid C…PMID 33034639 · 2020
reductions -33.6-38.8 to -28.4
Icosabutate, a Structurally Engineered Fatty Acid, Improves the Cardio…PMID 27160246 · 2016
Δ -7.40
Evidence for statin pleiotropy in humans: differential effects of stat…PMID 19075102 · 2009
RR 38.0
Efficacy and safety of fluvastatin in patients with non-insulin-depend…PMID 8198023 · 1994
decrease -24.3
Rosuvastatin in older patients with systolic heart failure.PMID 17984166 · 2007
Δ 37.1
4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

31 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
  2. Effect of atorvastatin on testosterone levels.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Antihypertensive effects of statins: a meta-analysis of prospective controlled studies.Journal of clinical hypertension (Greenwich, Conn.) · 2013 · on this map
    Pooled it
  4. Trial
  5. Trial
  6. Trial
  7. Trial
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Article
  13. Article
  14. Review
  15. Review
  16. Article
  17. Pulsatile Hemodynamics and Coronary Artery Disease.Korean circulation journal · 2021
    Review
  18. Article
  19. Observational
  20. Central Hemodynamics for Management of Arteriosclerotic Diseases.Journal of atherosclerosis and thrombosis · 2017
    Review
6 · The record

Corrections and comments

7 · Who and what money

Authors and funding

9 authors.

Bryan WilliamsDepartment of Cardiovascular Sciences, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK. bw17@le.ac.uk
Peter S Lacy
J Kennedy Cruickshank
David Collier
Alun D Hughes
Alice Stanton
Simon Thom
Herbert Thurston
CAFE and ASCOT Investigators

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundStatins reduce the risk of cardiovascular events in people with hypertension. This benefit could arise from a beneficial effect of statins on central aortic pressures and hemodynamics. The Conduit Artery Function Evaluation-Lipid-Lowering Arm (CAFE-LLA) study, an Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) substudy, investigated this hypothesis in a prospective placebo-controlled study of treated patients with hypertension. METHODS AND

resultsCAFE-LLA recruited 891 patients randomized to atorvastatin 10 mg/d or placebo from 5 centers in the United Kingdom and Ireland. Radial artery applanation tonometry and pulse-wave analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits over 3.5 years of follow-up. Atorvastatin lowered low-density lipoprotein cholesterol by 32.4 mg/dL (95% confidence interval [CI], 28.6 to 36.3) and total cholesterol by 35.1 mg/dL (95% confidence interval, 30.9 to 39.4) relative to placebo. Time-averaged brachial blood pressure was similar in CAFE-LLA patients randomized to atorvastatin or placebo (change in brachial systolic blood pressure, -0.1 mm Hg [95% CI, -1.8 to 1.6], P=0.9; change in brachial pulse pressure, -0.02 mm Hg [95% CI, -1.6 to 1.6], P=0.9). Atorvastatin did not influence central aortic pressures (change in aortic systolic blood pressure, -0.5 mm Hg [95% CI, -2.3 to 1.2], P=0.5; change in aortic pulse pressure, -0.4 mm Hg [95% CI, -1.9 to 1.0], P=0.6) and had no influence on augmentation index (change in augmentation index, -0.4%; 95% CI, -1.7 to 0.8; P=0.5) or heart rate (change in heart rate, 0.25 bpm; 95% CI, -1.3 to 1.8; P=0.7) compared with placebo. The effect of statin or placebo therapy was not modified by the blood pressure-lowering treatment strategy in the factorial design.

conclusionsStatin therapy sufficient to significantly reduce cardiovascular events in treated hypertensive patients in ASCOT did not influence central aortic blood pressure or hemodynamics in a large representative cohort of ASCOT patients in CAFE-LLA.

Indexed as

AortaAtorvastatinBlood PressureBrachial ArteryCholesterol, LDLFemaleHeptanoic AcidsHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHyperlipidemiasHypertensionMaleMiddle AgedPlacebosPulsatile FlowPyrrolesAtorvastatinCholesterol, LDLHeptanoic AcidsHydroxymethylglutaryl-CoA Reductase InhibitorsPlacebosPyrroles

Identifiers

PMID19103995

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.