mrcbhf heart protection strongstudystrong - ctsu.pptVIP

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: Average blood VITAMIN levelsduring follow-up 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 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 40mg daily: Safety monitoring SIMVASTATIN: Average LDL DIFFERENCE(mmol/l ± 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 SIMVASTATIN: Main conclusions After allowance for non-compliance, 40mg daily simvastatin safely reduces the 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 cereb