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The Lancet
Journal Prestige (SJR): 14.934
Citation Impact (citeScore): 9
Number of Followers: 2591  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0140-6736 - ISSN (Online) 1474-547X
Published by Elsevier Homepage  [3161 journals]
  • Management of intrahepatic cholestasis in pregnancy
    • Abstract: Publication date: Available online 14 February 2019Source: The LancetAuthor(s): Kirsten R Palmer, Liu Xiaohua, Ben W Mol
       
  • Immune response to non-HLA antigens and renal allograft loss
    • Abstract: Publication date: Available online 14 February 2019Source: The LancetAuthor(s): Stanley C Jordan
       
  • The Lancet Commission on women and cardiovascular disease: time for a
           shift in women's health
    • Abstract: Publication date: Available online 11 February 2019Source: The LancetAuthor(s): Roxana Mehran, Birgit Vogel, Rebecca Ortega, Rebecca Cooney, Richard Horton
       
  • Direct-acting antiviral treatment for hepatitis C
    • Abstract: Publication date: Available online 11 February 2019Source: The LancetAuthor(s): Jacinta A Holmes, Stephanie M Rutledge, Raymond T Chung
       
  • The global syndemic of obesity, undernutrition, and climate change
    • Abstract: Publication date: Available online 11 February 2019Source: The LancetAuthor(s): Emily Mendenhall, Merrill Singer
       
  • Increasing women's leadership in science in Ho Chi Minh City
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Ngo Thi Hoa, Nguyen Thuy Thuong Thuong, Hannah E Clapham, Tran Thi Anh Thu, Evelyne Kestelyn, C Louise Thwaites
       
  • Engaging men to support women in science, medicine, and global health
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Kopano Ratele, Ravi Verma, Salvador Cruz, Anisur Rahman Khan
       
  • More talk than action: gender and ethnic diversity in leading public
           health universities
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Mishal Sameer Khan, Fatim Lakha, Melisa Mei Jin Tan, Shweta Rajkumar Singh, Rina Yu Chin Quek, Emeline Han, See Mieng Tan, Victoria Haldane, Montserrat Gea-Sánchez, Helena Legido-QuigleySummaryImproving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge, which we believe might be addressed by including staff diversity data in university rankings. We present findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world, including an analysis of the intersection between sex and ethnicity. Our study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.
       
  • Organisational best practices towards gender equality in science and
           medicine
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Imogen R Coe, Ryan Wiley, Linda-Gail BekkerSummaryIn August 2018, the president of the World Bank noted that “‘Human capital’—the potential of individuals—is going to be the most important long-term investment any country can make for its people's future prosperity and quality of life”. Nevertheless, leaders and practitioners in academic science and medicine continue to be unaware of and poorly educated about the nature, extent, and impact of barriers to full participation of women and minorities in science and medicine around the world. This lack of awareness and education results in failures to fully mobilise the human capital of half the population and limits global technological and medical advancements. The chronic lack of recruitment, promotion, and retention of women in science and medicine is due to systemic, structural, organisational, institutional, cultural, and societal barriers to equity and inclusion. These barriers must be identified and removed through increased awareness of the challenges combined with evidence-based, data-driven approaches leading to measurable targets and outcomes. In this Review, we discuss these issues and highlight actions that could achieve gender equality in science and medicine. We survey approaches and insights that have helped to identify and remove systemic bias and barriers in science and medicine, and propose tools that will help organisational change toward gender equality. We describe tools that include formal legislation and mandated quotas at national or large-scale levels (eg, gender parity), techniques that increase fairness (eg, gender equity) through facilitated organisational cultural change at institutional levels, and professional development of core competencies at individual levels. This Review is not intended to be an extensive analysis of all the literature currently available on achieving gender equality in academic medicine and science, but rather, a reflection on finding multifactorial solutions.
       
  • Working toward gender diversity and inclusion in medicine: myths and
           solutions
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Sonia K Kang, Sarah KaplanSummaryWomen's representation in science and medicine has slowly increased over the past few decades. However, this rise in numbers of women, or gender diversity, has not been matched by a rise in gender inclusion. Despite increasing representation, women still encounter bias and discrimination when compared with men in these fields across a variety of outcomes, including treatment at school and work, hiring, compensation, evaluation, and promotion. Individual and systemic biases create unwelcome environments for women, particularly for those who additionally identify with other traditionally devalued groups (eg, women of colour). This Review draws on several decades of research in the field of management and its cognate disciplines to identify five myths that continue to perpetuate gender bias and five strategies for improving not only the number of women in medicine, but also their lived experiences, capacity to aspire, and opportunity to succeed. We argue for a move away from a singular focus on interventions aimed at targeting individual attitudes and behaviour to more comprehensive interventions that address structural and systemic changes.
       
  • Applying feminist theory to medical education
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Malika SharmaSummaryTo adequately address gendered issues of sexual harassment, wage gaps, and leadership inequities, medical institutions must interrogate medical education. Feminist theories can help to understand how power operates within our classrooms and at the bedside. This scoping review maps the four main ways in which feminist theory has been applied to medical education and medical education research—namely, critical appraisal of what is taught in medical curricula; exploration of the experiences of women in medical training; informing pedagogical approaches to how medicine is taught; and finally, medical education research, determining both areas of inquiry and methodologies. Feminist theory has the potential to move clinicians and educators from theory to action, building bridges of solidarity between the medical profession and the community it is called to serve.
       
  • Gender equality in science, medicine, and global health: where are we at
           and why does it matter'
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Geordan Shannon, Melanie Jansen, Kate Williams, Carlos Cáceres, Angelica Motta, Aloyce Odhiambo, Alie Eleveld, Jenevieve MannellSummaryThe purpose of this Review is to provide evidence for why gender equality in science, medicine, and global health matters for health and health-related outcomes. We present a high-level synthesis of global gender data, summarise progress towards gender equality in science, medicine, and global health, review the evidence for why gender equality in these fields matters in terms of health and social outcomes, and reflect on strategies to promote change. Notwithstanding the evolving landscape of global gender data, the overall pattern of gender equality for women in science, medicine, and global health is one of mixed gains and persistent challenges. Gender equality in science, medicine, and global health has the potential to lead to substantial health, social, and economic gains. Positioned within an evolving landscape of gender activism and evidence, our Review highlights missed and future opportunities, as well as the need to draw upon contemporary social movements to advance the field.
       
  • Why do women leave surgical training' A qualitative and feminist study
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Rhea Liang, Tim Dornan, Debra NestelSummaryBackgroundWomen are under-represented in surgery and leave training in higher proportions than men. Studies in this area are without a feminist lens and predominantly use quantitative methods not well suited to the complexity of the problem.MethodsIn this qualitative study, a researcher interviewed women who had chosen to leave surgical training. Women were recruited using a purposive snowball strategy through the routine communications of the Royal Australasian College of Surgeons and Royal Australasian College of Surgeons Trainee Association over a 3-week period, and were interviewed over the following 4 months in the past 4 years in person or by telephone. More specific details are available on request from the authors. Supported by male and female co-researchers, and in dialogue with study participants, she then coded the findings and defined themes. An explanatory model was developed by integrating findings with different theories and previous literature. The research team developed three aspects of the model into a visual analogue.Findings12 women participated in the study, with all Australian states and territories, and New Zealand, as well as five medical specialty streams, represented. The time spent in training ranged from 6 months to 4 years, and all participants, except two, had trained in both metropolitan and rural locations. The findings confirmed factors identified in earlier reports as reasons women leave surgical training, and contributed six new factors: unavailability of leave, a distinction between valid and invalid reasons for leave, poor mental health, absence of interactions with the women in surgery section of their professional body and other supports, fear of repercussion, and lack of pathways for independent and specific support. The relationships between factors was complex and sometimes paradoxical. The visual analogue is a tower of blocks, with each block representing a factor that contributed to the decision to leave surgical training, and with the toppling of the tower representing the choice to leave. The visual analogue indicates that effective action requires attention to the contributory factors, the small actions that can topple the tower, and the contexts in which the blocks are stacked.InterpretationWomen might be best helped by interventions that are alert to the possibility of unplanned negative effects, do not unduly focus on gender, and address multiple factors. This should inform interventions in surgical training, with attention to local social context, health-care setting, and training programme structure.FundingRoyal Australasian College of Surgeons Ian and Ruth Gough Surgical Education Scholarship.
       
  • Lessons from Sweden's feminist foreign policy for global health
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Rachel Elisabeth Irwin
       
  • Time for gender-transformative change in the health workforce
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Myra Betron, Ivy Bourgeault, Mehr Manzoor, Ema Paulino, Rosalind Steege, Kelly Thompson, Tana Wuliji, Global Health Workforce Network's Gender Equity Hub
       
  • De-patriarchalising and levelling science for French-speaking women
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Samiratou Ouédraogo, Lara Gautier, Muriel Mac-Seing, Stella Tine, Myriam Cielo Perez, Kadidiatou Kadio, Rolande Chegno, Catherine M Jones
       
  • Investing in gender equity in health and biomedical research: a Singapore
           perspective
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Joanne Yoong, Sylvie Alonso, Ching Wan Chan, Marie-Veronique Clement, Lina H K Lim, Sophia Archuleta
       
  • Female health volunteers of Nepal: the backbone of health care
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Nirmal Kandel, Jaya Lamichhane
       
  • Advancing women in STEM: institutional transformation
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Susan M Shaw, Michelle Bothwell, Kali Furman, Lisa Gaines, Deborah John, Cynthia Lopez, Nana Osei-Kofi, H Tuba Özkan-Haller, Dwaine Plaza, Bonnie Ruder, Rebecca L Warner
       
  • Achieving women's equity in academic medicine: challenging the standards
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jeanine D'Armiento, Susan S Witte, Kuheli Dutt, Melanie Wall, Geraldine McAllister, Columbia University Senate Commission on the Status of Women
       
  • Addressing women's under-representation in medical leadership
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Johnny Boylan, Jane Dacre, Harriet Gordon
       
  • The Mentor–Protégé Program in health research in Cameroon
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Pierrette Essama Mekongo, Sylvie Kwedi Nolna, Marceline Djuidje Ngounoue, Judith Torimiro Ndongo, Mireille Ndje Ndje, Celine Nkenfou Nguefeu, Julienne Nguefack, Evelyn Mah, Amani Adjidja, Barbara Atogho Tiedeu, Marielle Paty Ngassa, Veronique Penlap Beng, Rose Gana Fomban Leke
       
  • Promoting gender equity in grant making: what can a funder do'
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Sindy N Escobar Alvarez, Reshma Jagsi, Stephanie B Abbuhl, Carole J Lee, Elizabeth R Myers
       
  • Countries, parental occupation, and girls' interest in science
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jiesi Guo, Herbert W Marsh, Philip D Parker, Theresa Dicke, Brooke Van Zanden
       
  • Department of Error
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s):
       
  • #IToo
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Marceline Tutu van Furth, Mpho Tutu van Furth
       
  • The world is yours
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Henrik Österblom
       
  • Strengthening the role of ethnic minority women in science and medicine in
           China
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jiayue Hu, George Fu Gao, Ji-Long Chen
       
  • Supporting female scientists in Yemen
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Fathiah Zakham, Katia Jaton
       
  • Australia's strategy to achieve gender equality in STEM
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jane Latimer, Somali Cerise, Pavel V Ovseiko, Jill M Rathborne, Saraid S Billiards, Wafa El-Adhami
       
  • Why it must be a feminist global health agenda
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Sara E Davies, Sophie Harman, Rashida Manjoo, Maria Tanyag, Clare Wenham
       
  • Female global health leadership: data-driven approaches to close the
           gender gap
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jyoti S Mathad, Lindsey K Reif, Grace Seo, Kathleen F Walsh, Margaret L McNairy, Myung Hee Lee, Adolfine Hokororo, Aarti Kinikar, Claudia T Riche, Marie M Deschamps, Sandy Nerette, Smita Nimkar, Neema Kayange, Hyasinta Jaka, Glory Joseph, Domenica Morona, Thandiwe Yvonne Peter, Nishi Suryavanshi, Daniel W Fitzgerald, Jennifer A Downs
       
  • Gendered impacts of privatisation and austerity in eastern Europe
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Kristen R Ghodsee
       
  • Africa rising: gendered journeys of women patients and providers
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Miriam Mutebi
       
  • Women's value: beyond the business case for diversity and inclusion
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Cordelia Fine, Victor Sojo
       
  • Taking the battle against sexual harassment in global academia online
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Becky McCall
       
  • Offline: Gender and global health—an inexcusable global failure
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Richard Horton
       
  • What is The Lancet doing about gender and diversity'
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jocalyn Clark, Richard Horton
       
  • The missing trans women of science, medicine, and global health
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Arjee J Restar, Don Operario
       
  • Driving gender equity in African scientific institutions
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Barbara Atogho Tiedeu, Oluwafunmilayo Josephine Para-Mallam, Dorothy Nyambi
       
  • The good, the bad, and the ugly of implicit bias
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Cheryl Pritlove, Clara Juando-Prats, Kari Ala-leppilampi, Janet A Parsons
       
  • From #MeToo to #TimesUp in health care: can a culture of accountability
           end inequity and harassment'
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Esther K Choo, Carrie L Byington, Niva-Lubin Johnson, Reshma Jagsi
       
  • Measurement and meaning: reporting sex in health research
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Sarah Hawkes, Fariha Haseen, Hajer Aounallah-Skhiri
       
  • Preventing the tower from toppling for women in surgery
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Reshma Jagsi, Llewellyn Padayachy, Rebecca Surender
       
  • Funders should evaluate projects, not people
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Jennifer L Raymond, Miriam B Goodman
       
  • Feminism is for everybody
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): The Lancet
       
  • Athena SWAN and ADVANCE: effectiveness and lessons learned
    • Abstract: Publication date: 9–15 February 2019Source: The Lancet, Volume 393, Issue 10171Author(s): Sue V Rosser, Sarah Barnard, Molly Carnes, Fehmidah Munir
       
  • Increasing the dose intensity of chemotherapy by more frequent
           administration or sequential scheduling: a patient-level meta-analysis of
           37 298 women with early breast cancer in 26 randomised trials
    • Abstract: Publication date: Available online 8 February 2019Source: The LancetAuthor(s): Richard Gray, Rosie Bradley, Jeremy Braybrooke, Zulian Liu, Richard Peto, Lucy Davies, David Dodwell, Paul McGale, Hongchao Pan, Carolyn Taylor, William Barlow, Judith Bliss, Paolo Bruzzi, David Cameron, George Fountzilas, Sibylle Loibl, John Mackey, Miguel Martin, Lucia Del Mastro, Volker MöbusSummaryBackgroundIncreasing the dose intensity of cytotoxic therapy by shortening the intervals between cycles, or by giving individual drugs sequentially at full dose rather than in lower-dose concurrent treatment schedules, might enhance efficacy.MethodsTo clarify the relative benefits and risks of dose-intense and standard-schedule chemotherapy in early breast cancer, we did an individual patient-level meta-analysis of trials comparing 2-weekly versus standard 3-weekly schedules, and of trials comparing sequential versus concurrent administration of anthracycline and taxane chemotherapy. The primary outcomes were recurrence and breast cancer mortality. Standard intention-to-treat log-rank analyses, stratified by age, nodal status, and trial, yielded dose-intense versus standard-schedule first-event rate ratios (RRs).FindingsIndividual patient data were provided for 26 of 33 relevant trials identified, comprising 37 298 (93%) of 40 070 women randomised. Most women were aged younger than 70 years and had node-positive disease. Total cytotoxic drug usage was broadly comparable in the two treatment arms; colony-stimulating factor was generally used in the more dose-intense arm. Combining data from all 26 trials, fewer breast cancer recurrences were seen with dose-intense than with standard-schedule chemotherapy (10-year recurrence risk 28·0% vs 31·4%; RR 0·86, 95% CI 0·82–0·89; p
       
  • Dose intensification of chemotherapy for early breast cancer in the age of
           de-escalation
    • Abstract: Publication date: Available online 8 February 2019Source: The LancetAuthor(s): Sara A Hurvitz
       
  • Blood pressure lowering in acute ischaemic stroke thrombolysis
    • Abstract: Publication date: Available online 7 February 2019Source: The LancetAuthor(s): Else Charlotte Sandset, Urs Fischer
       
  • Intensive blood pressure reduction with intravenous thrombolysis therapy
           for acute ischaemic stroke (ENCHANTED): an international, randomised,
           open-label, blinded-endpoint, phase 3 trial
    • Abstract: Publication date: Available online 7 February 2019Source: The LancetAuthor(s): Craig S Anderson, Yining Huang, Richard I Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Qiang Li, Laurent Billot, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Alice C Durham, Pablo M Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O Martins, Veronica V Olavarria, Jeyaraj D PandianSummaryBackgroundSystolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intravenous alteplase in patients with acute ischaemic stroke, but the target systolic blood pressure for optimal outcome is uncertain. We assessed intensive blood pressure lowering compared with guideline-recommended blood pressure lowering in patients treated with alteplase for acute ischaemic stroke.MethodsWe did an international, partial-factorial, open-label, blinded-endpoint trial of thrombolysis-eligible patients (age ≥18 years) with acute ischaemic stroke and systolic blood pressure 150 mm Hg or more, who were screened at 110 sites in 15 countries. Eligible patients were randomly assigned (1:1, by means of a central, web-based program) within 6 h of stroke onset to receive intensive (target systolic blood pressure 130–140 mm Hg within 1 h) or guideline (target systolic blood pressure
       
  • Minimally invasive surgery plus alteplase for intracerebral haemorrhage
    • Abstract: Publication date: Available online 7 February 2019Source: The LancetAuthor(s): Rustam Al-Shahi Salman, Catharina J M Klijn, Magdy Selim
       
  • Considering prehospital stroke trials: did RIGHT-2 get it right'
    • Abstract: Publication date: Available online 6 February 2019Source: The LancetAuthor(s): Karen C Johnston, Valerie L Durkalski-Mauldin
       
  • Global public health challenges, fiscal policies, and yellow vest
    • Abstract: Publication date: Available online 5 February 2019Source: The LancetAuthor(s): Franco Sassi
       
  • Has the NHS Long Term Plan forgotten we are all going to die'
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Tracey Bleakley, Richard Smith, Ros Taylor
       
  • Efficacy and safety of statin therapy in older people: a meta-analysis of
           individual participant data from 28 randomised controlled trials
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Jane Armitage, Colin Baigent, Elizabeth Barnes, D John Betteridge, Lisa Blackwell, Michael Blazing, Louise Bowman, Eugene Braunwald, Robert Byington, Christopher Cannon, Michael Clearfield, Helen Colhoun, Rory Collins, Björn Dahlöf, Kelly Davies, Barry Davis, James de Lemos, John R Downs, Paul Durrington, Jonathan EmbersonSummaryBackgroundStatin therapy has been shown to reduce major vascular events and vascular mortality in a wide range of individuals, but there is uncertainty about its efficacy and safety among older people. We undertook a meta-analysis of data from all large statin trials to compare the effects of statin therapy at different ages.MethodsIn this meta-analysis, randomised trials of statin therapy were eligible if they aimed to recruit at least 1000 participants with a scheduled treatment duration of at least 2 years. We analysed individual participant data from 22 trials (n=134 537) and detailed summary data from one trial (n=12 705) of statin therapy versus control, plus individual participant data from five trials of more intensive versus less intensive statin therapy (n=39 612). We subdivided participants into six age groups (55 years or younger, 56–60 years, 61–65 years, 66–70 years, 71–75 years, and older than 75 years). We estimated effects on major vascular events (ie, major coronary events, strokes, and coronary revascularisations), cause-specific mortality, and cancer incidence as the rate ratio (RR) per 1·0 mmol/L reduction in LDL cholesterol. We compared proportional risk reductions in different age subgroups by use of standard χ2 tests for heterogeneity when there were two groups, or trend when there were more than two groups.Findings14 483 (8%) of 186 854 participants in the 28 trials were older than 75 years at randomisation, and the median follow-up duration was 4·9 years. Overall, statin therapy or a more intensive statin regimen produced a 21% (RR 0·79, 95% CI 0·77–0·81) proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol. We observed a significant reduction in major vascular events in all age groups. Although proportional reductions in major vascular events diminished slightly with age, this trend was not statistically significant (ptrend=0·06). Overall, statin or more intensive therapy yielded a 24% (RR 0·76, 95% CI 0·73–0·79) proportional reduction in major coronary events per 1·0 mmol/L reduction in LDL cholesterol, and with increasing age, we observed a trend towards smaller proportional risk reductions in major coronary events (ptrend=0·009). We observed a 25% (RR 0·75, 95% CI 0·73–0·78) proportional reduction in the risk of coronary revascularisation procedures with statin therapy or a more intensive statin regimen per 1·0 mmol/L lower LDL cholesterol, which did not differ significantly across age groups (ptrend=0·6). Similarly, the proportional reductions in stroke of any type (RR 0·84, 95% CI 0·80–0·89) did not differ significantly across age groups (ptrend=0·7). After exclusion of four trials which enrolled only patients with heart failure or undergoing renal dialysis (among whom statin therapy has not been shown to be effective), the trend to smaller proportional risk reductions with increasing age persisted for major coronary events (ptrend=0·01), and remained non-significant for major vascular events (ptrend=0·3). The proportional reduction in major vascular events was similar, irrespective of age, among patients with pre-existing vascular disease (ptrend=0·2), but appeared smaller among older than among younger individuals not known to have vascular disease (ptrend=0·05). We found a 12% (RR 0·88, 95% CI 0·85–0·91) proportional reduction in vascular mortality per 1·0 mmol/L reduction in LDL cholesterol, with a trend towards smaller proportional reductions with older age (ptrend=0·004), but this trend did not persist after exclusion of the heart failure or dialysis trials (ptrend=0·2). Statin therapy had no effect at any age on non-vascular mortality, cancer death, or cancer incidence.InterpretationStatin therapy produces significant reductions in major vascular events irrespective of age, but there is less direct evidence of benefit among patients older than 75 years who do not already have evidence of occlusive vascular disease. This limitation is now being addressed by further trials.FundingAustralian National Health and Medical Research Council, National Institute for Health Research Oxford Biomedical Research Centre, UK Medical Research Council, and British Heart Foundation.
       
  • Department of Error
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s):
       
  • Department of Error
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s):
       
  • Possibility for science without borders in the Trump era
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Shahin Akhondzadeh
       
  • Top ten hyperacusis research priorities in the UK
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Kathryn Fackrell, Linda Stratmann, Toto Anne Gronlund, Derek J Hoare, Hyperacusis Priority Setting Partnership Steering Group
       
  • Repetitive transcranial magnetic stimulation for depression –
           Authors' reply
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Daniel M Blumberger, Fidel Vila-Rodriguez, Kevin E Thorpe, Zafiris J Daskalakis, Jonathan Downar
       
  • Repetitive transcranial magnetic stimulation for depression
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Adam Mourad Chekroud, Ioana Alina Cristea
       
  • Baricitinib for systemic lupus erythematosus – Authors' reply
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Daniel J Wallace, Richard A Furie, Yoshiya Tanaka, Stephanie de Bono, Robert W Hoffman
       
  • Baricitinib for systemic lupus erythematosus
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Kai Yuan, Guangrui Huang, Xiaopu Sang, Anlong Xu
       
  • Global burden of postoperative death
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Dmitri Nepogodiev, Janet Martin, Bruce Biccard, Alex Makupe, Aneel Bhangu, Dmitri Nepogodiev, Janet Martin, Bruce Biccard, Alex Makupe, Adesoji Ademuyiwa, Adewale Oluseye Adisa, Maria-Lorena Aguilera, Sohini Chakrabortee, J. Edward Fitzgerald, Dhruva Ghosh, James C. Glasbey, Ewen M. Harrison, J.C. Allen Ingabire, Hosni Salem, Marie Carmela Lapitan
       
  • Lisa M Schwartz
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Adam Marcus
       
  • A tense moment in the emergency room
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Danielle Ofri
       
  • Scientific collaboration in Michael Lewis's The Undoing Project
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Dhruv Khullar, Daniel Marchalik
       
  • Influenza
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Richard Barnett
       
  • Unsavory Truth: How Food Companies Skew the Science of What We Eat, Marion
           Nestle. Basic Books (2018), 320, US$25·98, ISBN: 9781541617315
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Sarah Boseley
       
  • Canada's updated food guide promotes mindful eating
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Paul Webster
       
  • Health agenda close to absent in Nigeria's election campaign
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Paul Adepoju
       
  • Doctor strikes in Zimbabwe: fighting for provision of health
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Munyaradzi Makoni
       
  • Offline: India's health crisis: will democracy deliver'
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Richard Horton
       
  • Evidence-based medicine and infertility treatment
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Sjoerd Repping
       
  • Never too old for statin treatment'
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Bernard M Y Cheung, Karen S L Lam
       
  • Abandoning the stigma of leprosy
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): The Lancet
       
  • Adding insult to injury—redefining domestic abuse
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): The Lancet
       
  • Britain is broken: poor child health proves it
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): The Lancet
       
  • Chinese herbal remedy found to contain steroids and antifungals
    • Abstract: Publication date: 2–8 February 2019Source: The Lancet, Volume 393, Issue 10170Author(s): Kristian Fredløv Mose, Anette Bygum
       
  • Introduction of genomics into prenatal diagnostics
    • Abstract: Publication date: Available online 31 January 2019Source: The LancetAuthor(s): Michael E Talkowski, Heidi L Rehm
       
  • Network analyses to rank pharmacological treatments for generalised
           anxiety disorder
    • Abstract: Publication date: Available online 31 January 2019Source: The LancetAuthor(s): Borwin Bandelow, Dirk Wedekind
       
  • The 21st-century great food transformation
    • Abstract: Publication date: Available online 16 January 2019Source: The LancetAuthor(s): Tamara Lucas, Richard Horton
       
  • Food in the Anthropocene: the EAT–Lancet Commission on healthy diets
           from sustainable food systems
    • Abstract: Publication date: Available online 16 January 2019Source: The LancetAuthor(s): Walter Willett, Johan Rockström, Brent Loken, Marco Springmann, Tim Lang, Sonja Vermeulen, Tara Garnett, David Tilman, Fabrice DeClerck, Amanda Wood, Malin Jonell, Michael Clark, Line J Gordon, Jessica Fanzo, Corinna Hawkes, Rami Zurayk, Juan A Rivera, Wim De Vries, Lindiwe Majele Sibanda, Ashkan Afshin
       
  • Carbohydrate and human health: is it all about quality'
    • Abstract: Publication date: Available online 10 January 2019Source: The LancetAuthor(s): Edward S Chambers, Claire S Byrne, Gary Frost
       
  • Does bovine lactoferrin prevent late-onset neonatal sepsis'
    • Abstract: Publication date: Available online 8 January 2019Source: The LancetAuthor(s): Lex W Doyle, Jeanie L Y Cheong
       
 
 
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