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dc.contributor.authorPyŏrälä, K
dc.contributor.authorPedersen, T R
dc.contributor.authorKjekshus, J
dc.contributor.authorFaergeman, O
dc.contributor.authorOlsson, A G
dc.contributor.authorThorgeirsson, G
dc.date.accessioned2010-09-20T15:22:16Z
dc.date.available2010-09-20T15:22:16Z
dc.date.issued1997-04-01
dc.date.submitted2010-09-20
dc.identifier.citationDiabetes Care. 1997, 20(4):614-20en
dc.identifier.issn0149-5992
dc.identifier.pmid9096989
dc.identifier.urihttp://hdl.handle.net/2336/111474
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractOBJECTIVE: To assess in diabetic patients with coronary heart disease (CHD) the effect of cholesterol lowering with simvastatin on mortality and the risk of CHD and other atherosclerotic events. RESEARCH DESIGN AND METHODS: A post hoc subgroup analysis was carried out on data from 202 diabetic patients and 4,242 nondiabetic patients with previous myocardial infarction or angina pectoris, serum total cholesterol 5.5-8.0 mmol/l, and serum triglycerides < or = 2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S). Participants in the 4S were randomly assigned to double-blind treatment with simvastatin, 20 mg daily, with blinded dosage titration up to 40 mg daily, according to cholesterol response during the first 6-18 weeks, or placebo. Endpoints were 1) total mortality, 2) major CHD events (CHD death or nonfatal myocardial infarction), 3) other acute atherosclerotic events, 4) myocardial revascularization procedures. RESULTS: Over the 5.4-year median follow-up period, simvastatin treatment produced mean changes in serum lipids in diabetic patients similar to those observed in nondiabetic patients. The relative risks (RRs) of main endpoints in simvastatin-treated diabetic patients were as follows: total mortality 0.57 (95% CI, 0.30-1.08; P = 0.087), major CHD events 0.45 (95% CI, 0.27-0.74; P = 0.002), and any atherosclerotic event 0.63 (95% CI, 0.43-0.92; P = 0.018). The corresponding RRs in nondiabetic patients were the following: 0.71 (95% CI, 0.58-0.87; P = 0.001), 0.68 (95% CI, 0.60-0.77; P < 0.0001), and 0.74 (95% CI, 0.68-0.82; P < 0.0001). CONCLUSIONS: The results strongly suggest that cholesterol lowering with simvastatin improves the prognosis of diabetic patients with CHD. The absolute clinical benefit achieved by cholesterol lowering may be greater in diabetic than in nondiabetic patients with CHD because diabetic patients have a higher absolute risk of recurrent CHD events and other atherosclerotic events.
dc.language.isoenen
dc.publisherAmerican Diabetes Associationen
dc.relation.urlhttp://proquest.umi.com/pqdlink?did=13411993&Fmt=7&clientId=131689&RQT=309&VName=PQDen
dc.subject.meshAnticholesteremic Agentsen
dc.subject.meshArteriosclerosisen
dc.subject.meshBlood Pressureen
dc.subject.meshCholesterolen
dc.subject.meshCholesterol, HDLen
dc.subject.meshCholesterol, LDLen
dc.subject.meshCoronary Diseaseen
dc.subject.meshDiabetic Angiopathiesen
dc.subject.meshDouble-Blind Methoden
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshLovastatinen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshMyocardial Infarctionen
dc.subject.meshMyocardial Revascularizationen
dc.subject.meshPlacebosen
dc.subject.meshPrognosisen
dc.subject.meshRisk Factorsen
dc.subject.meshScandinaviaen
dc.subject.meshSimvastatinen
dc.subject.meshSurvival Rateen
dc.subject.meshTime Factorsen
dc.subject.meshTriglyceridesen
dc.titleCholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)en
dc.typeArticleen
dc.contributor.departmentDepartment of Medicine, University of Kuopio, Finland.en
dc.identifier.journalDiabetes careen
html.description.abstractOBJECTIVE: To assess in diabetic patients with coronary heart disease (CHD) the effect of cholesterol lowering with simvastatin on mortality and the risk of CHD and other atherosclerotic events. RESEARCH DESIGN AND METHODS: A post hoc subgroup analysis was carried out on data from 202 diabetic patients and 4,242 nondiabetic patients with previous myocardial infarction or angina pectoris, serum total cholesterol 5.5-8.0 mmol/l, and serum triglycerides < or = 2.5 mmol/l who were participating in the Scandinavian Simvastatin Survival Study (4S). Participants in the 4S were randomly assigned to double-blind treatment with simvastatin, 20 mg daily, with blinded dosage titration up to 40 mg daily, according to cholesterol response during the first 6-18 weeks, or placebo. Endpoints were 1) total mortality, 2) major CHD events (CHD death or nonfatal myocardial infarction), 3) other acute atherosclerotic events, 4) myocardial revascularization procedures. RESULTS: Over the 5.4-year median follow-up period, simvastatin treatment produced mean changes in serum lipids in diabetic patients similar to those observed in nondiabetic patients. The relative risks (RRs) of main endpoints in simvastatin-treated diabetic patients were as follows: total mortality 0.57 (95% CI, 0.30-1.08; P = 0.087), major CHD events 0.45 (95% CI, 0.27-0.74; P = 0.002), and any atherosclerotic event 0.63 (95% CI, 0.43-0.92; P = 0.018). The corresponding RRs in nondiabetic patients were the following: 0.71 (95% CI, 0.58-0.87; P = 0.001), 0.68 (95% CI, 0.60-0.77; P < 0.0001), and 0.74 (95% CI, 0.68-0.82; P < 0.0001). CONCLUSIONS: The results strongly suggest that cholesterol lowering with simvastatin improves the prognosis of diabetic patients with CHD. The absolute clinical benefit achieved by cholesterol lowering may be greater in diabetic than in nondiabetic patients with CHD because diabetic patients have a higher absolute risk of recurrent CHD events and other atherosclerotic events.


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