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The Heart Protection Study (HPS) was a large UK, placebo-controlled, randomised trial of cholesterol-lowering with simvastatin 40mg daily versus placebo and of anti-oxidant vitamin supplementation, using a combination of vitamin C, vitamin E and beta carotene versus matching placebo. Between 1994 and 1997, 20,536 patients at increased risk of vascular disease were randomised in 69 hospital-based clinics around the UK. These patients were followed up for an average of 5 years in the study clinics while they continued on their randomised treatment, and then for a further 5 years by annual postal questionnaire.

HPS was designed to be really large, to involve a big reduction in blood LDL cholesterol levels and a substantial increase in antioxidant vitamin levels, and to include a wide range of patients at high risk of death from heart disease and other causes. It provided reliable evidence about the effects of these cholesterol-lowering treatments and antioxidant vitamin supplements on mortality and major morbidity in a wide range of circumstances.

The HPS has shown that:

  • Reduction in LDL-cholesterol with simvastatin 40mg daily reduced the risk of death by 13% (due to a reduction in death from vascular causes by 18% with no adverse effect on non-vascular causes) and of major vascular events (MVEs i.e. heart attacks, strokes or coronary or non-coronary revascularisation) by about one quarter in a wide range of different types of patient (including women, people with diabetes, and the elderly) among whom there was uncertainty about the benefits of cholesterol-lowering
  • Supplementation with anti-oxidant vitamins is safe but does not reduce the risk of  major vascular events
  • Cholesterol-lowering with simvastatin 40mg daily was well tolerated, with no difference in the reports of muscle pain between those on statin versus placebo and a small excess of myopathy (muscle symptoms with raised blood creatine kinase) of about 1 per 10,000 per year.
  • Cholesterol-lowering with simvastatin 40mg is cost-effective in a variety of settings
  • The effect of cholesterol-lowering for 5 years with simvastatin 40mg has no adverse effects over 11 years on cancer or other causes of mortality, and long term follow up of HPS participants continues
  • The associations of major vascular events with a variety of plasma and genetic biomarkers have been investigated in the HPS data including CRP, BNP, KIF-6 and LpPLA2, and data from HPS has contributed to a number of meta-analyses of randomized trials and observational studies

The HPS database continues to provide valuable information on other risk factors, including Lp(a) and genetic factors. On-going investigations include looking at the very long-term effects of cholesterol-lowering and anti-oxidant vitamins on vascular and non-vascular events and cancers using data from electronic health records.

The HPS trial was funded by the UK Medical Research Council, the British Heart Foundation and by Merck, who also provided simvastatin and matching placebo, and Roche who provided the anti-oxidant vitamin capsules and matching placebo. The long-term follow-up was funded by a grant from the British Heart Foundation and epidemiological studies have been funded by core grants to CTSU from the Medical Research Council, British Heart Foundation and Cancer Research UK.

HPS: serious adverse events by MedRA classification


Long-Term Follow-Up

In the UK, we will continue to collect information on health outcomes by obtaining routinely collected data via central data registries and NHS sources. We will also be using information from blood samples provided by participants during the main trial to investigate genetic risks and causes of vascular and other related diseases (e.g. dementia).

See our Long-term Follow-up Information for Participants document for more information about this long-term follow-up, and our Privacy Notice for information on how we use participant data.

Our team

  • Jane Armitage
    Jane Armitage

    Professor of Clinical Trials and Epidemiology, and Honorary Consultant in Public Health Medicine

  • Richard Bulbulia
    Richard Bulbulia

    Research Fellow, Clinical Trial Service Unit, University of Oxford

  • Robert Clarke
    Robert Clarke

    Emeritus Professor of Epidemiology and Public Health Medicine

  • Rory Collins
    Rory Collins

    Head of Oxford Population Health and BHF Professor of Medicine and Epidemiology

  • Jemma Hopewell
    Jemma Hopewell

    Professor of Precision Medicine & Epidemiology

Selected publications

Related research themes