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Baseline characteristics of HPS participants by prior diabetes

Baseline characteristics of HPS participants by prior diabetes. HPS: Baseline lipids (mmol/L) and apolipoproteins (g/L) by prior diabetes. HPS: Baseline lipids (mg/dL) and apolipoproteins (g/L) by prior diabetes. HPS: FACTORIAL TREATMENT COMPARISONS.

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Baseline characteristics of HPS participants by prior diabetes

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  1. Baseline characteristics of HPS participants by prior diabetes

  2. HPS: Baseline lipids (mmol/L) and apolipoproteins (g/L) by prior diabetes

  3. HPS: Baseline lipids (mg/dL) and apolipoproteins (g/L) by prior diabetes

  4. HPS: FACTORIAL TREATMENT COMPARISONS

  5. HPS: Mean (SE) differences in lipids during follow-up by diabetes

  6. SIMVASTATIN: MAJOR CORONARY EVENTS and STROKE by prior DIABETES Vascular event SIMVASTATIN PLACEBO Rate ratio & 95% CI & disease group (10269) (10267) STATIN better PLACEBO better Major coronary events Diabetes 279 (9.4%) 377 (12.6%) No diabetes 619 (8.5%) 835 (11.5%) 27% SE 4 All patients 898 (8.7%) 1212 (11.8%) reduction (2P<0.00001) Strokes Diabetes 149 (5.0%) 193 (6.5%) No diabetes 295 (4.0%) 392 (5.4%) 25% SE 5 All patients 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  7. SIMVASTATIN: REVASCULARISATIONS and MAJOR VASCULAR EVENTS by prior DIABETES Vascular event SIMVASTATIN PLACEBO Rate ratio & 95% CI & disease group (10269) (10267) STATIN better PLACEBO better Revascularisations Diabetes 260 (8.7%) 309 (10.4%) No diabetes 679 (9.3%) 896 (12.3%) 24% SE 4 All patients 939 (9.1%) 1205 (11.7%) reduction (2P<0.00001) Major vascular events Diabetes 601 (20.2%) 748 (25.1%) No diabetes 1432 (19.6%) 1837 (25.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  8. SIMVASTATIN: MAJOR VASCULAR EVENT by YEAR in DIABETIC PATIENTS Year SIMVASTATIN PLACEBO Rate ratio & 95% CI of follow-up (2978) (2985) STATIN better PLACEBO better 1 143 (4.8%) 141 (4.7%) 2 110 (3.9%) 150 (5.3%) 3 109 (4.0%) 172 (6.5%) 4 101 (3.9%) 138 (5.6%) 5+ 138 (5.7%) 147 (6.4%) 22% SE 5 ALL FOLLOW-UP 601 (20.2%) 748 (25.1%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  9. SIMVASTATIN: MAJOR VASCULAR EVENTS by YEAR in DIABETIC PATIENTS 30 Logrank p<0.00001 25 PLACEBO 20 15 SIMVASTATIN 10 5 0 0 1 2 3 4 5 6 Years of follow-up Benefit/1000(SE) -1(6) 13(8) 34(9) 47(10) 51(15) 58(48) People suffering events (%)

  10. SIMVASTATIN: MAJOR VASCULAR EVENTS by PRIOR DISEASE & prior DIABETES Prior disease & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better CHD Diabetes 325 (33.4%) 381 (37.8%) No diabetes 1134 (19.8%) 1460 (25.7%) Other CVD Diabetes 141 (25.6%) 171 (32.9%) No diabetes 287 (19.8%) 362 (24.4%) No CVD Diabetes 135 (9.3%) 196 (13.5%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  11. SIMVASTATIN: MAJOR VASCULAR EVENTS by SEX & prior DIABETES Sex & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better Male Diabetes 471 (22.8%) 580 (27.8%) No diabetes 1195 (21.1%) 1555 (27.6%) Female Diabetes 130 (14.2%) 168 (18.6%) No diabetes 237 (14.6%) 282 (17.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  12. SIMVASTATIN: MAJOR VASCULAR EVENTS by AGE & prior DIABETES Age & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better <65 y Diabetes 263 (15.7%) 341 (20.1%) No diabetes 568 (17.6%) 750 (23.1%)  65 y Diabetes 338 (25.9%) 407 (31.6%) No diabetes 864 (21.3%) 1087 (26.9%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  13. SIMVASTATIN: MAJOR VASCULAR EVENTS by LDL CHOLESTEROL & prior DIABETES LDL cholesterol & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better <3.0 mmol/L Diabetes 191 (15.7%) 252 (20.9%) No diabetes 407 (18.8%) 504 (22.9%)  3.0 mmol/L Diabetes 410 (23.3%) 496 (27.9%) No diabetes 1025 (20.0%) 1333 (26.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  14. SIMVASTATIN: MAJOR VASCULAR EVENTS by TRIGLYCERIDES & prior DIABETES Triglycerides & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better <2.0 mmol/L Diabetes 270 (16.8%) 364 (22.8%) No diabetes 831 (18.9%) 1068 (24.1%)  2.0 mmol/L Diabetes 331 (24.1%) 384 (27.6%) No diabetes 601 (20.8%) 769 (27.1%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  15. SIMVASTATIN: MAJOR VASCULAR EVENTS by HDL CHOLESTEROL & prior DIABETES HDL cholesterol & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better <0.9 mmol/L Diabetes 288 (25.9%) 356 (31.1%) No diabetes 530 (21.1%) 708 (29.3%)  0.9 mmol/L Diabetes 313 (16.8%) 392 (21.3%) No diabetes 902 (18.9%) 1129 (23.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  16. SIMVASTATIN: MAJOR VASCULAR EVENTS by ApoB/ApoA1 ratio & prior DIABETES ApoB/ApoA1 ratio & SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better <1.0 mmol/L Diabetes 301 (16.9%) 382 (21.6%) No diabetes 717 (18.3%) 899 (22.9%)  1.0 mmol/L Diabetes 300 (25.2%) 366 (30.1%) No diabetes 715 (21.3%) 937 (27.9%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  17. SIMVASTATIN: MAJOR VASCULAR EVENTS by DURATION OF DIABETES Duration (years) SIMVASTATIN PLACEBO Rate ratio & 95% CI (10269) (10267) STATIN better PLACEBO better <6 203 (18.9%) 247 (23.0%)  6 <13 201 (20.8%) 241 (25.6%)  13 197 (21.0%) 259 (26.7%) No diabetes 1432 (19.6%) 1837 (25.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  18. SIMVASTATIN: MAJOR VASCULAR EVENTS by TYPE OF DIABETES Type of SIMVASTATIN PLACEBO Rate ratio & 95% CI diabetes (10269) (10267) STATIN better PLACEBO better Type 1 43 (13.7%) 53 (17.5%) Type 2 558 (20.9%) 695 (25.9%) No diabetes 1432 (19.6%) 1837 (25.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  19. SIMVASTATIN: MAJOR VASCULAR EVENTS by HbA1c HbA1c (%) SIMVASTATIN PLACEBO Rate ratio & 95% CI (10269) (10267) STATIN better PLACEBO better <7.0 294 (18.3%) 360 (22.6%)  7.0 301 (22.6%) 373 (27.5%) No diabetes 1432 (19.6%) 1837 (25.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  20. SIMVASTATIN: HbA1c (% ± SE) amonga sample with DIABETES at entry

  21. SIMVASTATIN: Development of DIABETES in patients not known to have diabetes at entry

  22. SIMVASTATIN: Change in blood CREATININE (µmol/l ± se) from baseline to 4 years

  23. HPS: Effects of SIMVASTATIN on first and all major vascular events in those with and without diabetes

  24. P S 30 P S 20 P S 10 9% 13% 20% 25% 31% 36% 0 Diabetesalone Occlusive arterial disease alone Both arterial disease and diabetes Absolute effects of simvastatin allocation on 5-year rates of first major vascular event Risk reductions (SE): 18.4% (5.7) Proportional 32.9% (9.1) 24.5% (3.1) 44 (12) Absolute/1000 62 (8) 66 (21) P-value 0.0003 <0.0001 0.002 40 S=simvastatin-allocated P=placebo-allocated Proportion with first major vascular event (%)

  25. HPS: Conclusions for people with diabetes • Lowering LDL cholesterol by 1 mmol/L (40 mg/dL) reduces the risk of major vascular events by about one-quarter during 5 years of treatment • Similar proportional reductions in risk among people with or without diabetes ― irrespective of age, sex, vascular disease or lipid levels • Continued statin treatment prevents not only first but also subsequent major vascular events

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