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"MRC/BHF Heart Protection Study of
cholesterol lowering with simvastatin in 20,356 high-risk
individuals: a randomised placebo-controlled trial,"
by R. Collins, et al. (the Heart Protection Study
Collaborative Group), The Lancet, 360(9326): 7-22, 6 July 2002.
[Author's affiliations: Multiple U.K.
institutions; study based at Radcliffe Infirmary, Oxford, U.K.]
From the Summary: "Background
Throughout the usual LDL cholesterol range in Western populations, lower blood
concentrations are associated with lower cardiovascular disease risk. In such
populations, therefore, reducing LDL cholesterol may reduce the development of
vascular disease, largely irrespective of initial cholesterol concentrations.
Methods 20 356 UK adults (aged 40-80 years) with coronary disease, other
occlusive arterial disease, or diabetes were randomly allocated to receive 40
mg simvastatin daily (average compliance: 85%) or matching placebo (average
non-study statin use: 17%). Analyses are of the first occurrence of particular
events, and compare all simvastatin-allocated versus all placebo-allocated
participants. These "intention-to-treat" comparisons assess the
effects of about two-thirds (85% minus 17%) taking statin during the scheduled
5-year treatment period, which yielded an average difference in LDL
cholesterol of 1.0 mmol/L (about two-thirds of the effect of actual use of 40
mg simvastatin daily). Primary outcomes were mortality (for overall analyses)
and fatal or non-fatal vascular events (for subcategory analyses), with
subsidiary assessments of cancer and of other major morbidity....Interpretation
Adding simvastatin to existing treatments safely produces substantial
additional benefits for a wide range of high-risk patients, irrespective of
their initial cholesterol concentrations. Allocation to
40 mg simvastatin daily reduced the rates of myocardial infarction, of stroke,
and of revascularization by about one-quarter. After making allowance for
non-compliance, actual use of this regimen would probably reduce these rates
by about one-third. Hence, among the many types of high-risk individuals
studied, 5 years of simvastatin would prevent about 70-100 people per 1000
from suffering at least one of these major vascular events (and longer
treatment should produce further benefit). The size of the 5-year benefit
depends chiefly on such individuals' overall risk of major vascular events,
rather than on their blood lipid concentrations alone."
This 2002 report from The Lancet was
cited 68 times in current journal article indexed in the Thomson
ISI
database during May-June 2003. Its latest two-month total made this the
second-most-cited paper in medicine
published in the last two years, aside from reviews. Prior to the most recent
bimonthly count, citations to the paper
have accrued as follows:
March-April 2003: 86 citations
January-February 2003: 63
November-December 2002: 33
October-November 2002: 11
Total citations to date: 261
SOURCE: Hot
Papers Database (Included with a subscription to the ISI print newsletter Science
Watch®, available from the ISI
Research Services Group. Packaged on a CD-ROM that is mailed with each Science
Watch issue, the Hot
Papers Database contains data on hundreds of highly cited papers published
during the last two years. User interface permits searching by author,
organization, journal, field, and more. Total citations, as well as citations
accrued during successive bimonthly periods, can be assessed and graphed. An
updated CD containing the most recent bimonthly data is mailed with every new
issue of Science
Watch,
six times a year. The CD also includes an electronic version of the Science
Watch
issue in HTML format, for personal desktop access.)
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