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ELIGIBILITY: MRC/BHF Heart Protection Study

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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 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
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 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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