Effect of statins and aspirin alone and in combination on clinical outcome in dyslipidaemic patients with coronary heart disease. A subgroup analysis of the GREACE study

Declaration of interest: The GREACE study was conducted independently; no Company or Institution has supported it financially. Some of the authors have attended conferences and participated in other trials sponsored by various pharmaceutical companies. We assessed the possible 'synergy' of statins and aspirin (ASA) in reducing vascular events in patients with coronary heart disease, in a post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation ( GREACE) study. All patients (n=1600) were divided into four groups according to long-term treatment: Group A (n=787; statin+ASA), B (n=93; statin-no ASA), C (n=599; no statin-on ASA) and D (n=121; no statin-no ASA). From all patients 692 were either on a statin or ASA monotherapy (Groups B+C). Relative risk reductions (RRRs) in 'all events' (primary endpoint) between groups were assessed. During the 3-year follow-up there were 292 cardiovascular events; 92 (2% of patients) in Group A, 14 (15%) in group B, 144 in Group C (24%) and 42 events in Group D (35%). The total number of events in Group B+C was 158 (23%). The RRRs in the primary endpoint were: Group A versus B 24% (P=0.1912), A versus C 51% (P<0.0001), A versus B+C 49% (P<0.0001) and A versus D 71% (P<0.0001). The RRRs in Group B versus C was 36% (P=0.0431) and B versus D 57% (P=0.0012), while in C versus D 33% (P=0.0084). Our findings show that statins and ASA have an additive effect in reducing cardiovascular events. Aggressive statin use in the absence of ASA also substantially reduced cardiovascular events. Treatment with ASA in the absence of statin use reduced clinical events in comparison to patients not treated with either drug.