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


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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

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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


Eligibility mrc bhf heart protection study

PRIOR DISEASE at BASELINE


Eligibility mrc bhf heart protection study

AGE & SEX at BASELINE


Eligibility mrc bhf heart protection study

TOTAL & LDL CHOLESTEROL at BASELINE


Eligibility mrc bhf heart protection study

FACTORIAL TREATMENT COMPARISONS


Vitamins average blood vitamin levels during follow up

VITAMINS: Average blood VITAMIN levelsduring follow-up


Eligibility mrc bhf heart protection study

VITAMINS: CATARACT and FRACTURES


Eligibility mrc bhf heart protection study

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


Eligibility mrc bhf heart protection study

FACTORIAL TREATMENT COMPARISONS


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


Eligibility mrc bhf heart protection study

SIMVASTATIN 40mg daily: Muscle symptoms


Simvastatin 40mg daily safety monitoring

SIMVASTATIN 40mg daily: Safety monitoring


Eligibility mrc bhf heart protection study

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)


Millions of people with relevant conditions

Millions of people with relevant conditions


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