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dc.contributor.authorPedersen, T R
dc.contributor.authorOlsson, A G
dc.contributor.authorFaergeman, O
dc.contributor.authorKjekshus, J
dc.contributor.authorWedel, H
dc.contributor.authorBerg, K
dc.contributor.authorWilhelmsen, L
dc.contributor.authorHaghfelt, T
dc.contributor.authorThorgeirsson, G
dc.contributor.authorPyörälä, K
dc.contributor.authorMiettinen, T
dc.contributor.authorChristophersen, B
dc.contributor.authorTobert, J A
dc.contributor.authorMusliner, T A
dc.contributor.authorCook, T J
dc.date.accessioned2010-07-28T11:25:56Z
dc.date.available2010-07-28T11:25:56Z
dc.date.issued1998-04-21
dc.date.submitted2010-07-28
dc.identifier.citationCirculation. 1998, 97(15):1453-60en
dc.identifier.issn0009-7322
dc.identifier.pmid9576425
dc.identifier.urihttp://hdl.handle.net/2336/108545
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: The Scandinavian Simvastatin Survival Study (4S) randomized 4444 patients with coronary heart disease (CHD) and serum cholesterol 5.5 to 8.0 mmol/L (213 to 310 mg/dL) with triglycerides < or =2.5 mmol/L (220 mg/dL) to simvastatin 20 to 40 mg or placebo once daily. Over the median follow-up period of 5.4 years, one or more major coronary events (MCEs) occurred in 622 (28%) of the 2223 patients in the placebo group and 431 (19%) of the 2221 patients in the simvastatin group (34% risk reduction, P<.00001). Simvastatin produced substantial changes in several lipoprotein components, which we have attempted to relate to the beneficial effects observed. METHODS AND RESULTS: The Cox proportional hazards model was used to assess the relationship between lipid values (baseline, year 1, and percent change from baseline at year 1) and MCEs. The reduction in MCEs within the simvastatin group was highly correlated with on-treatment levels and changes from baseline in total and LDL cholesterol, apolipoprotein B, and less so with HDL cholesterol, but there was no clear relationship with triglycerides. We estimate that each additional 1% reduction in LDL cholesterol reduces MCE risk by 1.7% (95% CI, 1.0% to 2.4%; P<.00001). CONCLUSIONS: These analyses suggest that the beneficial effect of simvastatin in individual patients in 4S was determined mainly by the magnitude of the change in LDL cholesterol, and they are consistent with current guidelines that emphasize aggressive reduction of this lipid in CHD patients.
dc.language.isoenen
dc.publisherLippincott Williams & Wilkinsen
dc.relation.urlhttp://circ.ahajournals.org/cgi/content/abstract/97/15/1453en
dc.subject.meshAdulten
dc.subject.meshAgeden
dc.subject.meshAnticholesteremic Agentsen
dc.subject.meshCholesterolen
dc.subject.meshCholesterol, Dietaryen
dc.subject.meshCoronary Diseaseen
dc.subject.meshDouble-Blind Methoden
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHumansen
dc.subject.meshIncidenceen
dc.subject.meshLipoproteinsen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshMyocardial Infarctionen
dc.subject.meshPredictive Value of Testsen
dc.subject.meshRegression Analysisen
dc.subject.meshRisk Factorsen
dc.subject.meshSensitivity and Specificityen
dc.subject.meshSimvastatinen
dc.subject.meshTriglyceridesen
dc.titleLipoprotein changes and reduction in the incidence of major coronary heart disease events in the Scandinavian Simvastatin Survival Study (4S)en
dc.typeArticleen
dc.contributor.departmentAker Hospital, Oslo, Norway.en
dc.identifier.journalCirculationen
html.description.abstractBACKGROUND: The Scandinavian Simvastatin Survival Study (4S) randomized 4444 patients with coronary heart disease (CHD) and serum cholesterol 5.5 to 8.0 mmol/L (213 to 310 mg/dL) with triglycerides < or =2.5 mmol/L (220 mg/dL) to simvastatin 20 to 40 mg or placebo once daily. Over the median follow-up period of 5.4 years, one or more major coronary events (MCEs) occurred in 622 (28%) of the 2223 patients in the placebo group and 431 (19%) of the 2221 patients in the simvastatin group (34% risk reduction, P<.00001). Simvastatin produced substantial changes in several lipoprotein components, which we have attempted to relate to the beneficial effects observed. METHODS AND RESULTS: The Cox proportional hazards model was used to assess the relationship between lipid values (baseline, year 1, and percent change from baseline at year 1) and MCEs. The reduction in MCEs within the simvastatin group was highly correlated with on-treatment levels and changes from baseline in total and LDL cholesterol, apolipoprotein B, and less so with HDL cholesterol, but there was no clear relationship with triglycerides. We estimate that each additional 1% reduction in LDL cholesterol reduces MCE risk by 1.7% (95% CI, 1.0% to 2.4%; P<.00001). CONCLUSIONS: These analyses suggest that the beneficial effect of simvastatin in individual patients in 4S was determined mainly by the magnitude of the change in LDL cholesterol, and they are consistent with current guidelines that emphasize aggressive reduction of this lipid in CHD patients.


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