Differences in the treatment of coronary heart disease between countries as revealed in the Scandinavian Simvastatin Survival Study (4S)
OBJECTIVE
To assess differences in treatment of ischaemic heart disease in the Scandinavian countries.


RESULTS
The Scandinavian Simvastatin Survival Study (4S) lasted 5.4 years and showed that death rates in 4444 patients with coronary heart disease were 30% lower in those treated with simvastatin to lower serum cholesterol than in those given placebo. Apart from this main result, the 4S provided detailed information on rates of death and other manifestations of coronary heart disease, as well as on use of non-lipid forms of therapy. There were substantial differences in 4S placebo group rates of mortality, coronary deaths and major coronary events between countries. Surgical and medical therapy varied importantly between countries.


CONCLUSIONS
Major inter-country differences in rates of death and myocardial infarction in patients with coronary heart disease were likely to be due to a composite of differences in baseline characteristics including smoking. They occurred in a setting of very uneven exploitation of the potential for improving survival of patients with ischaemic heart disease.
Faergeman
O
O
Department of Medicine and Cardiology, Aarhus Amtssygehus, Aarhus, Denmark.
Kjekshus
J
J
Cook
T
T
Pyörälä
K
K
Wilhelmsen
L
L
Thorgeirsson
G
G
Pedersen
T R
TR
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002423:Cause of Death; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011379:Prognosis; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D019821:Simvastatin / Q000627:therapeutic use*; D015996:Survival Rate; D014859:Warfarin / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D000924:Anticholesteremic Agents; D002121:Calcium Channel Blockers; D014859:Warfarin; D019821:Simvastatin; D001241:Aspirin