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ISCHAEMIC HEART DISEASE
Treat a "normal" cholesterol if the patient is at vascular risk 
In over 20 000 patients with proven coronary artery disease, other vascular disease or diabetes, simvastatin 40 mg was compared to placebo. Considering that 17% in the placebo arm were on a statin, and 85% in the treatment arm took the drug, the effect of treatment at five years was a significant reduction in all cause mortality (12.9% v 14.7%, p = 0.0003). This was due to a highly significant 18% (standard error 5) proportional reduction in the coronary death rate (5.7% v 6.9%, p = 0.0005). The rates of cerebrovascular accident, non-fatal myocardial infarction, and revascularisation were also reduced. Low density lipoprotein (LDL) was reduced by 1 mmol/l on average, starting from an average of 3.3 mmol/l. The benefits remain for patients with total cholesterol < 5 mmol/l and LDL < 3 mmol/l.
Heart Protection Study Collaborative Group
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