Heart Protection Study

Secondary prevention study (Heart Protection Study)... 

Heart Protection Study Collaborative Group, MRC/BHF Heart Protection Smdy of antioxidant vitamin supplementation in 20,536 high-risk individuals a randomised placebo-controlled trial. Lancet, 360, 23, 2002. 

Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet 2004 363 757-67. 

Collins R, Peto R, and Armitage J. The MCR/BHF Heart Protection Study preUmtnary results. Int J Clin Pract 2002 56 53-56. 

In high-risk individuals and groups people with clinical evidence of macrovascular disease other than CHD, the Heart Protection Study (HPS) (II) with diabetes, the HPS and Collaborative Atorvastatin Diabetes Study (CARDS) (12) the elderly, Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) (13) or with hypertension, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) (14) and Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) (15). 

Collins R, Armitage J, Parish S, Sleigh P Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes a randomised placebo-controlled trial. Lancet 2003 361 2005-20l 6. 

These elfects on cerebrovascular events and on intermittent claudication suggest that simvastatin and other elfective lipid-lowering treatments may have a general antiatherosclerotic elfect not limited to the coronary bed. Definitive evidence on the elfects of statin therapy in stroke prevention and peripheral vessel disease is likely to be provided by the Heart Protection Study (MRC/BHF Heart Protection Study Collaborative Group, 1999). As noted above, this UK study has randomized over 20,000 patients aged up to 80 to simvastatin 40 mg or placebo, and the 5-year treatment period is scheduled for completion in 2001. Among these patients are 3288 patients with a history of cerebrovascular disease. Because of its size and the broad array of patient types randomized, this study should also provide reliable evidence of the elfect of simvastatin on coronary morbidity and mortality in women, elderly patients, patients with low levels of LDL and HDL cholesterol, patients with peripheral vascular disease, and diabetic patients with or without coronary disease (MRC/BHF Heart Protection Study Collaborative Group, 1999). 

Based on clinical trial evidence and cost, generic simvastatin 20 mg or 40 mg daily would seem a reasonable first-line choice. In the largest statin trial to date, the Heart Protection Study (2002), which included people with and without existing coronary heart disease (CHD), simvastatin 40 mg was associated with a significant 27% reduction in major coronary events (CHD death plus non-fatal myocardial infarction), equating to an NNT (number needed to treat) of 32 over 5 years. 

Data from the Heart Protection Study of cholesterol lowering in patients with known vascular disease or diabetes have shown that such therapy reduces the risk of stroke on... 

The authors estimated that 5 years of statin treatment will prevent 100 major vascular events in every 1000 patients with previous myocardial infarction, or 70-80 events in patients with other forms of coronary heart disease or diabetes. There was no upper age limit to this benefit, and no lower limit to the level of LDL at which benefit was seen. Heart Protection Study Collaborative Group 2002 MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals. Lancet 360 7-22. 

Consensus minimum targets for primary and secondary prevention of CHD with statins are a total plasma cholesterol of < 5 mmol/1 (or a reduction of 20-25% if the result is lower) or a LDL-cholesterol of < 3 mmol/1 (or a reduction of 30% if that is lower). These may be revised in the light of the Heart Protection Study (see... 

The Heart Protection Study randomly allocated 20,536 adults with coronary artery disease, occlusive disease of noncoronary arteries, or diabetes to simvastatin (40 mg) or placebo. In a subgroup analysis of more than 1300 patients with plasma creatinine concentration between 1.2mg/dL and 2.3mg/dL (110 and 200 pmol/L), there were fewer major vascular events in the simvastatin group. 

Heart Protection Study Collaborative Group, Lancet, 360,23 43 (2002). 

HMGR 3-hydroxy-3-methylglutaryl coenzyme A reductase HPS Heart Protection Study HR Hazard ratio... 

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