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.

Stopping the CHAOS ▸Vitamin supplementation does not benefit the heart. The CHAOS study helped the cause of vitamin E, but the heart protection study, with 20 000 participants taking vitamin E + vitamin C + vitamin A, showed no benefits over five years' follow up. The same was true of long term follow up data from the physicians health study. The message is …