In the last decade, there have been several large- scale randomised controlled trials of lipid lowering therapy using 3-hydroxy-2-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) showing convincingly that lipid lowering therapy reduces cardiovascular events in patients with previous cardiovascular events (secondary prevention) and in hypercholesterolaemic patients who have not had such previous events (primary prevention).1,2 The recently published MRC/BHF Heart Protection Study is the first large clinical trial involving subjects who have a wide range of baseline cholesterol concentrations and who may not have had previous coronary events.3 20,536 adults in the United Kingdom were randomised in a 2 x 2 factorial design to either simvastatin or placebo, plus either a cocktail of antioxidant vitamins (vitamin E, vitamin C and β-carotene) or placebo. These subjects were considered to be at risk from coronary disease and include patients with known coronary artery disease, non-haemorrhagic cerebrovascular disease, peripheral vascular disease, diabetes mellitus (type 1 and type 2) and hypertension (men at least 65 years old). Notably, hypercholesterolaemia was not an inclusion criterion; the non-fasting total cholesterol only needed to be at least 3.5 mmol/L (135 mg/dL).
Bernard Man-Yung Cheung, Chu-Pak Lau, New Opportunities and Challenges in Heart Protection Journal of the Hong Kong College of Cardiology 2003;11(1) https://doi.org/10.55503/2790-6744.1133
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