title: Reduction of cardiovascular events by simvastatin in nondiabetic coronary heart disease patients with and without the metabolic syndrome: subgroup analyses of the Scandinavian Simvastatin Survival Study (4S).
abstract: OBJECTIVE
  To assess the effect of simvastatin treatment on the risk of cardiovascular events in nondiabetic patients with coronary heart disease (CHD) with and without the metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III).
  
  
  METHODS
  Subgroup analyses were performed on data from 3933 nondiabetic patients with clinically established CHD, serum total cholesterol level 5.5-8.0 mmol/l, and serum triglyceride level <or=2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S), a randomized, placebo-controlled trial. End points were total mortality, coronary mortality, major CHD event, myocardial revascularization, any CHD event, stroke, and any atherosclerotic event.
  
  
  RESULTS
  Over the 5.4-year median follow-up period, simvastatin produced similar changes in serum lipid levels in 893 patients with the metabolic syndrome and in 3040 patients without the metabolic syndrome. The relative risks of main end points in simvastatin-treated patients compared with placebo-treated patients with the metabolic syndrome were as follows: total mortality 0.54 (95% CI 0.36-0.82), coronary mortality 0.39 (0.23-0.65), major CHD event 0.59 (0.45-0.77), and any atherosclerotic event 0.69 (0.56-0.84). The corresponding RRs in patients without the metabolic syndrome were 0.72 (0.56-0.91), 0.62 (0.45-0.84), 0.71 (0.61-0.82), and 0.76 (0.68-0.85).
  
  
  CONCLUSIONS
  Nondiabetic CHD patients with or without the metabolic syndrome realize from simvastatin treatment a similar, substantial relative reduction in the risk of cardiovascular events. The absolute benefit may be greater in patients with the metabolic syndrome because they are at a higher absolute risk.
authors.affiliation: Department of Medicine, Kuopio University Hospital, Kuopio, Finland. kalevi.pyorala@uku.fi
authors.forename: Kalevi
authors.initials: K
authors.lastname: Pyörälä
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Barry
authors.initials: B
authors.lastname: Gumbiner
authors.forename: Michael W
authors.initials: MW
authors.lastname: Lee
authors.forename: Arvind
authors.initials: A
authors.lastname: Shah
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Davies
authors.forename: Yale B
authors.initials: YB
authors.lastname: Mitchel
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.forename: John
authors.initials: J
authors.lastname: Kjekshus
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control; D003327:Coronary Disease / Q000188:drug therapy*; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D010919:Placebos; D019821:Simvastatin / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010919:Placebos; D019821:Simvastatin