1 / 46

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

camden-scott
Download Presentation

ELIGIBILITY: MRC/BHF Heart Protection Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. 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

  2. PRIOR DISEASE at BASELINE

  3. AGE & SEX at BASELINE

  4. TOTAL & LDL CHOLESTEROL at BASELINE

  5. FACTORIAL TREATMENT COMPARISONS

  6. VITAMINS: Average blood VITAMIN levelsduring follow-up

  7. VITAMINS: CATARACT and FRACTURES

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

  9. 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

  10. FACTORIAL TREATMENT COMPARISONS

  11. STATIN USE: Compliance with study simvastatin or use of non-study statin

  12. 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

  13. SIMVASTATIN 40mg daily: Muscle symptoms

  14. SIMVASTATIN 40mg daily: Safety monitoring

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

  16. SIMVASTATIN: Average LDL DIFFERENCE(mmol/l ± se) by BASELINE LDL cholesterol

  17. SIMVASTATIN: Average LDL DIFFERENCE (mg/dl ± se) by BASELINE LDL cholesterol

  18. 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)

  19. 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)

  20. Millions of people with relevant conditions

More Related