View source for Scandinavian Simvastatin Survival Study

'''The Scandinavian Simvastatin Survival Study''' (also known under the abbreviation '''4S''') is a multicenter [[clinical trial]] that was performed in 1990s in [[Scandinavia]].

The objective of the study was to assess effect of a [[cholesterol]]-lowering drug called [[simvastatin]] on mortality and morbidity in a group of 4444 patients with [[coronary heart disease]], aged between 35 and 70 years.

The patients exhibited moderate [[hypercholesterolemia]], between 5.5 and 8.0 mmol/l.

The trial showed that treatment of patients suffering from coronary heart disease with simvastatin had a lowering effect on mortality and morbidity.

2223 patients were assigned [[placebo]] and 2221 were assigned simvastatin treatment for a mean period of 5.4 years.  There was a 30% relative reduction in the risk of death with simvastatin treatment.  The absolute coronary heart disease-mortality was reduced from 8.5% to 5.0%, making the [[number needed to treat]] around 30 (thirty patients would need to be treated to prevent one death).  Additionally there was no excess morbidity of non-cardiac deaths from causes like [[cancer]] or [[suicide]], a concern that has occasionally arisen in respect to the statins.

The treatment of 100 patients for six years would prevent four deaths of the disease and seven non-fatal [[Myocardial infarction|myocardial infarcts]].

The 4S study turned out to be a milestone in [[cardiology]] and [[evidence-based medicine]] - it was clearly proven that treatment with statins saved lives of patients with coronary heart disease.  A host of other large multicenter clinical trials followed that paved way to widespread use of this class of pharmaceuticals.

==References==
* The Scandinavian Simvastatin Survival Study Group. Randomized trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).  Lancet 1994;344:1383-1389 PMID 7968073
* The Scandinavian Simvastatin Survival Study Group. Design and baseline results of the Scandinavian Simvastatin Survival Study of patients with stable angina and/or previous myocardial infarction. Am J Cardiol 1993;71:393-400 PMID 8430625
* Pedersen, T.R., L.Wilhelmsen, O.Faergeman, et al.: Follow-up study of patients randomized in the Scandinavian Simvastatin Survival Study (4S) of cholesterol lowering. Am J Cardiol 2000;86:257-262 PMID 10922429

[[Category:Epidemiology]]
[[Category:Cardiology]]
[[Category:Statins|*]]
[[Category:Clinical trials]]
[[Category:2Fix]]