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editorial
. 2000 Oct;84(4):357–360. doi: 10.1136/heart.84.4.357

Need for large scale randomised evidence about lowering LDL cholesterol in people with diabetes mellitus: MRC/BHF heart protection study and other major trials

J ARMITAGE, R COLLINS
PMCID: PMC1729443  PMID: 10995396

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Figure 1  .

Figure 1  

CHD risk versus usual total cholesterol in people with and without diabetes mellitus. MRFIT prospective follow up study of CHD death rates during an average of 16 years in 5245 men aged 35-57 years with diabetes mellitus and 350 977 without diabetes8 (J Neaton, personal communication). Death rates are plotted on a doubling scale, and "usual" cholesterol concentrations at the start of follow up have been derived from baseline measurements of cholesterol by correcting for "regression dilution". The area of each square is proportional to the statistical information with ±1SE denoted by a vertical line.

Figure 2  .

Figure 2  

Observed effects on major CHD events in randomised controlled trials of cholesterol lowering with statin treatment among patients with pre-existing CHD, subdivided by diagnosed diabetes at entry. 4S compared 20-40 mg daily simvastatin versus placebo, and the average difference in total cholesterol was 1.7 mmol/l10 13; CARE and LIPID compared 40 mg daily pravastatin versus placebo, and the average differences in total cholesterol were 1.1 and 1.0 mmol/l, respectively.11 12 14 Odds ratios for CHD events in each trial are plotted as black squares, with area proportional to the number of events, and 99% confidence intervals (CIs) are denoted by horizontal lines. Odds ratios and 95% CI for subtotals and all CHD patients are plotted as open diamonds, with proportional reductions (± SD) given alongside.


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