Vascular disease is the leading cause of death in many countries. Statins are usually only given to people who have heart disease and raised blood cholesterol. New findings from the Heart Protection Study (HPS) led by Rory Collins from the University of Oxford's Clinical Trial Service Unit show that statins also reduce the risk of heart attack and stroke in people who have diabetes, arterial disease, or in individuals who have previously had a stroke. Most strikingly, the study found substantial benefits even among those high-risk patients considered to have "normal" or "low" blood cholesterol concentrations. The HPS study provides definite evidence that guidelines should be changed so that a statin is considered for anybody at an increased risk of heart attack or stroke-regardless of their blood cholesterol concentration.

Over 20,000 UK adults (aged 40-80) with coronary disease, other occlusive arterial disease, or diabetes were randomly allocated to receive daily doses of 40 mg simvastatin or placebo for five years. Death from all causes was reduced from 14.7% (for patients given placebo) to 12.9% (for patients given simvastatin), mainly due to an 18% relative reduction in the coronary death rate in patients assigned simvastatin.

There were also relative reductions of around 25% for non-fatal heart attack or coronary death, for non-fatal or fatal stroke, and for coronary or non-coronary revascularisation. Simvastatin was well tolerated with no major side-effects, and its benefits were additional to those of other cardioprotective treatments such as aspirin, - -blockers, and ACE inhibitors.

HPS also assessed the effects of using antioxidant vitamin supplements (600mg vitamin E, 250mg vitamin C and 20mg beta-carotene daily) in people
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Contact: Richard Lane
richard.lane@lancet.com
44-20-7424-4949
Lancet
4-Jul-2002