Editing Heart Protection Study

{{Infobox project
| name = Heart Protection Study
| logo =
| image =File:Simvastatin3Dan.gif
| caption = Simvastatin 3D
| mission_statement =
| commercial =
| type = [[randomized controlled trial]]
| products =
| location =
| country = [[United Kingdom]]
| owner =
| founder =
| primeminister =
| key_people =
| established =
| disestablished =
| funding = *[[Medical Research Council (UK)|Medical Research Council]] (MRC)
* [[British Heart Foundation]] (BHF)
| budget =
| current_status = Completed
| website = <!-- {{URL|example.com}} -->
}}
The '''Heart Protection Study''' was a [[randomized controlled trial]] run by the [[Clinical Trial Service Unit]], and funded by the [[Medical Research Council (UK)|Medical Research Council]] (MRC) and the [[British Heart Foundation]] (BHF) in the [[United Kingdom]]. It studied the use of the [[statin|cholesterol lowering drug]], [[simvastatin]] 40&nbsp;mg and [[vitamin]] supplementation ([[vitamin E]], [[vitamin C]] and [[carotene|beta carotene]]) in people who were at risk of [[cardiovascular disease]]. It was led by [[Jane Armitage]], an epidemiologist at the [[Clinical Trial Service Unit]].<ref>{{Cite web |title=Professor Jane Armitage recognised for services to medical research — Oxford Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU) |url=https://www.ctsu.ox.ac.uk/news/professor-jane-armitage-recognised-for-services-to-medical-research |access-date=2019-06-19 |website=www.ctsu.ox.ac.uk}}</ref><ref name="Aung2012">{{Cite book |last=Myat |first=Aung |url=https://books.google.com/books?id=DDmYywOVlToC&pg=PA32 |title=Landmark Papers in Cardiovascular Medicine |last2=Gershlick |first2=A. H. |last3=Gershlick |first3=Tony |date=2012 |publisher=[[Oxford University Press]] |isbn=978-0-19-959476-4 |pages=32 |language=en}}</ref>

==Results==
An outline of the study protocol was published in 1999.<ref>{{Cite journal |year=1999 |title=MRC/BHF Heart Protection Study of cholesterol-lowering therapy and of antioxidant vitamin supplementation in a wide range of patients at increased risk of coronary heart disease death: Early safety and efficacy experience |journal=European Heart Journal |volume=20 |issue=10 |pages=725–41 |doi=10.1053/euhj.1998.1350 |pmid=10329064 |doi-access=free}}</ref> Initial results<ref>{{Cite journal |last=Heart Protection Study Collaborative Group |year=2002 |title=MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebocontrolled trial |journal=[[The Lancet]] |volume=360 |issue=9326 |pages=7–22 |doi=10.1016/S0140-6736(02)09327-3 |pmid=12114036 |s2cid=35836642}}</ref> were published in 2002, which indicated that vitamins made little difference in modifying cardiovascular risk, but that simvastatin could significantly reduce the risk of cardiovascular events. Further publications, from 2003 and 2004, were concerned with the efficacy of simvastatin in diabetes patients<ref>{{Cite journal |last=Collins |first=R |last2=Armitage |first2=J |last3=Parish |first3=S |last4=Sleigh |first4=P |last5=Peto |first5=R |last6=Heart Protection Study Collaborative Group |year=2003 |title=MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: A randomised placebo-controlled trial |journal=Lancet |volume=361 |issue=9374 |pages=2005–16 |doi=10.1016/s0140-6736(03)13636-7 |pmid=12814710 |s2cid=28111189}}</ref> and preventing stroke.<ref>{{Cite journal |last=Collins |first=R |last2=Armitage |first2=J |last3=Parish |first3=S |last4=Sleight |first4=P |last5=Peto |first5=R |last6=Heart Protection Study Collaborative Group |year=2004 |title=Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions |journal=The Lancet |volume=363 |issue=9411 |pages=757–67 |doi=10.1016/S0140-6736(04)15690-0 |pmid=15016485 |s2cid=42044530}}</ref> A 2005 paper analyses the cost-effectiveness of a prescribing strategy similar to the one employed in the study.<ref>{{Cite journal |last=Mihaylova |first=B |last2=Briggs |first2=A |last3=Armitage |first3=J |last4=Parish |first4=S |last5=Gray |first5=A |last6=Collins |first6=R |last7=Heart Protection Study Collaborative Group |year=2005 |title=Cost-effectiveness of simvastatin in people at different levels of vascular disease risk: Economic analysis of a randomised trial in 20,536 individuals |journal=The Lancet |volume=365 |issue=9473 |pages=1779–85 |doi=10.1016/S0140-6736(05)63014-0 |pmid=15910950 |s2cid=39040005 |doi-access=free}}</ref>

==Interpretation==
The HPS is to date the largest study to investigate the use of [[statin]]s in the prevention of [[cardiovascular disease]]. While there have been concerns about side-effects associated with statins ([[myopathy]] and [[rhabdomyolysis]]), these were rare in this study.{{citation needed|date=April 2020}}

The [[number needed to treat]] in the study was 57 to postpone one death and 19 to prevent one cardiovascular "event" (in those taking the drug simvastatin for 5 years). There was no mortality benefit in women with a statistical "p-value" that did not reach significance (0.08) while the Kaplan-Meier mortality curves, for men and women separately, have not been published as of 2016. [[Cancer]] risk was not significantly lower in the treatment group; in fact, there was no difference except for non-melanoma skin cancers, wherein the placebo group had a barely-significant lower risk of diagnosis. No worsening of [[lung disease]] was found, an initial concern with statin drugs, and simvastatin did not decrease [[osteoporosis]].{{citation needed|date=April 2020}}

==Pharmaceutical funding==
£5.5M plus drug supply was received from Merck and £5.5M plus drug supply from Roche.
<ref>{{Cite journal |year=2014 |title=Grants to Oxford University for any Clinical Trial Service Unit (CTSU) trials or other commercially-funded research over the past 20 years |url=https://journals.bmj.com/sites/default/files/BMJ/statins/SP21_CTSU_grants_May_2014.pdf |journal=[[British Medical Journal]]}}</ref>

==See also==
* [[HDL-Atherosclerosis Treatment Study]]
* [[West of Scotland Coronary Prevention Study]]
* [[Scandinavian Simvastatin Survival Study]]

==References==
{{reflist}}

== Further reading ==
* [http://www.hpsinfo.org Study homepage] at the [[Clinical Trial Service Unit]]
* [https://web.archive.org/web/20040405020532/http://www.jr2.ox.ac.uk/bandolier/booth/cardiac/HPS.html Bandolier condensation of the HPS results]

[[Category:Clinical trials related to cardiology]]
[[Category:Cardiology]]
[[Category:Epidemiological study projects]]
[[Category:Statins]]