Day 252 - 20 May 96 - Page 33


     
     1        CHD at 40 years and a 19 percent reduction at 80 years.
     2        In older people the relative risk may be less in part
     3        because of lifestyle changes and premature CHD death among
     4        the most susceptible."
     5
     6        Would you agree with what is written there, the parts that
     7        I have read out?
     8        A.   Yes, that seems to be a reasonable analysis of the
     9        data, yes.
    10
    11   Q.   In paragraph 5.2.2, the last four lines say:
    12
    13        "The estimated true reduction in coronary risk associated
    14        with a 1 per cent reduction in plasma cholesterol
    15        concentration, after adjustment for errors in invariables,
    16        approaches 3 percent compared to the 2 percent observed in
    17        the unadjusted data from epidemiological studies."
    18
    19        Would you agree with that?
    20        A.   Well, I could not dispute it.  I am sure it must have
    21        been carefully worked out.
    22
    23   MR. JUSTICE BELL:  Could you keep your voice up, please,
    24        Professor?
    25
    26   MS. STEEL:  Then on the following page, starting on the fourth
    27        line, it says:
    28
    29        "In fourteen trials of under 4 years duration a 10 percent
    30        reduction in plasma cholesterol led to a 10 percent
    31        reduction in risk compared with a 20 per cent reduction in
    32        the 8 trials of more prominent intervention.  An analysis
    33        of 28 trials by Law et al showed that the full effect of
    34        the reduction in risk was achieved by 5 years when the
    35        achieved reduction is similar to that observed in
    36        prospective studies."
    37
    38        Would you agree with that?
    39        A.   Yes, I cannot dispute that.
    40
    41   Q.   If you then turn over to page 113, under the "blood
    42        pressure" section, which is 5.3.2.  At 5.3.1:
    43
    44        Systolic and diastolic blood pressure are directly related
    45        to the risk of coronary heart disease and stroke."
    46
    47        It goes on but I will not read it all out but if you read
    48        it to yourself.
    49
    50   MR. JUSTICE BELL:   Can you keep your voice up, please, Miss 
    51        Steel.  No doubt it is my hearing, but I find it less of an 
    52        effort to hear everything if it is loud and clear.  Anyway, 
    53        you want to read 5.3.1?
    54
    55   MS. STEEL:  "An overview analysis of 9 prospective studies,
    56        which together followed about 420,000, adults (96 percent
    57        men) for an average of 10 years showed the relation between
    58        CHD stroke incident and diastolic blood pressure to be
    59        linear positive and continuous across the range of
    60        pressures studied. When adjustments were made for the

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