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ELIGIBILITY: MRC/BHF Heart Protection Study. Increased risk of CHD death due to prior disease: Myocardial infarction or other coronary heart disease; Occlusive disease of non-coronary arteries; or Diabetes mellitus or treated hypertension Age 40-80 years

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Eligibility mrc bhf heart protection study
ELIGIBILITY: MRC/BHF Heart Protection Study

  • Increased risk of CHD death due to prior disease:

  • Myocardial infarction or other coronary heart disease;

  • Occlusive disease of non-coronary arteries; or

  • Diabetes mellitus or treated hypertension

  • Age 40-80 years

  • Total cholesterol >3.5 mmol/l (>135mg/dl)

  • Statin or vitamins not considered clearly indicated or contraindicated by patient’s own doctors








VITAMINS: COGNITIVE IMPAIRMENT(TICS-m <22/39) at Final Follow-up


Vitamins summary of findings
VITAMINS: Summary of findings

  • This antioxidant vitamin regimen (600mg E, 250mg C & 20mg beta carotene daily) increased blood vitamin levels substantially

  • These vitamins appeared to be safe, but did not reduce the 5-year risks of any type of vascular disease, cancer or other major outcome

  • Given these results, continued recommendation of supplementation with such vitamins is difficult to justify



Statin use compliance with study simvastatin or use of non study statin
STATIN USE: Compliance with study simvastatin or use of non-study statin


Hps assesses 2 3 of the effect of actually using 40mg simvastatin daily
HPS assesses 2/3 of the effect of actually using 40mg simvastatin daily

  • Average proportions using statin during HPS: 5/6 of active group vs 1/6 of control group

  • LDL difference in HPS (active vs control group) is ~2/3 of LDL difference from actually using statin

  • Risk reduction in HPS (active vs control group) is ~2/3 of risk reduction from actually using statin

  • ACTUAL EFFECT = 1.5 x APPARENT EFFECT




SIMVASTATIN: COGNITIVE IMPAIRMENT(TICS-m <22/39) at Final Follow-up


Simvastatin average ldl difference mmol l se by baseline ldl cholesterol
SIMVASTATIN: Average LDL DIFFERENCE(mmol/l ± se) by BASELINE LDL cholesterol


Simvastatin average ldl difference mg dl se by baseline ldl cholesterol
SIMVASTATIN: Average LDL DIFFERENCE (mg/dl ± se) by BASELINE LDL cholesterol


Simvastatin major vascular event in upper lower thirds of baseline ldl

Statin-allocated

Placebo-allocated

Upper

LDL third

Lower

LDL third

SIMVASTATIN: MAJOR VASCULAR EVENT in upper & lower thirds of baseline LDL

30

25

% with major vascular events

20

15

1.5

2.0

2.5

3.0

3.5

4.0

Average LDL cholesterol (mmol/l)


Simvastatin main conclusions
SIMVASTATIN: Main conclusions

  • After allowance for non-compliance, 40mg daily simvastatin safely reducesthe risk of heart attack, of stroke, and of revascularisation by about one-third

  • 5 years of statin treatment typically prevents these “major vascular events” in about:

  • 100 of every 1000 people with previous MI

  • 80 " " " other CHD

  • 70 " " " cerebrovascular disease

  • 70 " " " other arterial disease

  • 70 " " " diabetes (age 40+)

  • irrespective of cholesterol level(or age, or sex, or other treatments)



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