title: [The Scandinavian Simvastatin Survival Study: the clinical consequences].
abstract: In the recently reported Scandinavian Simvastatin Survival Study (4S), 4,444 men and women between 35 and 70 years of age who had coronary heart disease and plasma total cholesterol concentrations of 212 to 310 mg per deciliter (5.5 to 8.0 mmol/l) received simvastatin or placebo for 5.4 years; in the treatment group, mortality from coronary heart disease was 42 percent lower and mortality from all causes was 30 percent lower. Further analysis of the relation between the risk of major coronary events and baseline cholesterol levels in patients randomised to placebo or simvastatin therapy in the study showed that simvastatin significantly reduced the risk of major coronary events in all quartiles of baseline total, high-density-lipoprotein, and low-density-lipoprotein cholesterol, by a similar amount in each quartile. Clearly, cholesterol-modifying interventions can substantially improve the outlook for patients with coronary heart disease and should be considered in identification and treatment of patients with established coronary heart disease. The available data from secondary intervention trials indicates that all patients with documented ischemic heart disease should be offered a reliable assessment of plasma total cholesterol. However, since the impact of simvastatin on CHD seems to begin after about one year of therapy it would be reasonable to exclude very old persons and patients with serious disease with a limited life-expectancy. As a consequence of the 4S data it should be recommended that all the patients in question, who after lifestyle modifications and non-pharmacological risk factor modification still have total cholesterol levels above 200 mg per deciliter (5.2 mmol) should be offered treatment with a HMG-CoA reductase inhibitor.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D008148:Lovastatin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D019821:Simvastatin; D017741:Survivors / Q000706:statistics & numerical data
chemical_list: D000924:Anticholesteremic Agents; D008148:Lovastatin; D019821:Simvastatin
vernacular_title: Scandinavian Simvastatin Survival Study: consecuencias clínicas.