Tlitle
The Heart Protection Study
Purpose
To analyse the effects of simvastatin in patients at risk
of death from coronary artery disease (CAD) having low to
average LDL cholesterol levels
Design
Randomized, placebo-controlled study
Patients
20,356 patients with total cholesterol>135 mg/dl and
who met one of the following criteria: prior myocardial
infarction, any other CAD, occlusive disease of noncoronary
arteries (peripheral vascular disease or stroke), diabetes
mellitus or treated hypertension
Follow-up
5 years
Treatment regimen
Simvastatin 40 mg vs. Antioxidant therapy with vitamin
E (600 mg), vitamin C (250 mg) and beta carotene (20 mg)
vs. Placebo
Results
• Simvastatin caused a significant reduction in vascular
and all-cause mortality
• Simvastatin reduced stroke by 27%
• Simvastatin reduced major vascular events (MI, stroke
and revascularisation) by 24%
• Benefit was observed even in patients with baseline
LDL level lower than the recommended target level of 100
mg/dl
• Benefits of statin therapy increased with each year
of therapy and were irrespective of age, gender, or baseline
total
cholesterol or LDL levels
• Simvastatin was well tolerated; there was no significant
increase in liver or muscle enzymes
• Antioxidant vitamin therapy did not have any benefit
on all-cause mortality, vascular
or non-vascular mortality
Conclusion
• Simvastatin 40 mg/day reduced risk of heart attack,
stroke and revascularisation procedures by at least one
third
• This benefit was totally independent of initial lipid
values, including levels that are lower than published target
goal levels
• Even in diabetic patients without any evidence of
vascular disease, simvastatin demonstrated benefit
• The study confirmed the benefit of statin treatment
in the prevention of stroke
• It is never too late to initiate treatment - even
patients older than 75 years of age exhibited a sustained
benefit from this
Treatment
• There may no longer be a need to check a lipid profile
prior to initiation of a statin.
Ref: Presented at the American Heart Association, Nov
2001
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