The Scandinavian Simvastatin Survival Study (also known under the abbreviation 4S) is a multicenter clinical trial that was performed in 1990s in Scandinavia. Jump to: navigation, search In medicine, a clinical trial (synonyms: clinical studies, research protocols, medical research) is a research study. ... Jump to: navigation, search // Events and trends The 1990s are generally classified as having moved slightly away from the more conservative 1980s, but otherwise retaining the same mindset. ... Jump to: navigation, search Scandinavia, Fennoscandia, and the Kola Peninsula. ...

The objective of the study was to assess effect of cholesterol-lowering drug called simvastatin on mortality and morbidity in group of 4444 patients with coronary heart disease, aged between 35 and 70 years. Cholesterol is a steroid, a lipid, and an alcohol, found in the cell membranes of all body tissues, and transported in the blood plasma of all animals. ... In pharmacology, simvastatin (Zocor®, Zocor Heart Pro®, marketed by the pharmaceutical company Merck & Co. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ...

The patients presented with moderate hypercholesterolemia between 5.5 and 8.0 mmol/l. Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ...

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

2223 patients were assigned placebo and 2221 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 CHD-mortality was reduced from 8.5% down 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 mortality was reduced from 11,5% to 8,2%, making the number needed to treat around 164. A placebo, from the Latin for I will please, is a medical treatment (operation, therapy, chemical solution, pill, etc. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ... Jump to: navigation, search When normal cells are damaged or old they undergo apoptosis; cancer cells, however, avoid apoptosis. ... Jump to: navigation, search Suicide (from Latin sui caedere, to kill oneself) is the act of willfully ending ones own life; it is sometimes a noun for one who has committed or attempted the act. ... The number needed to treat (NNT) is an epidemiological measure that indicates how many patients would require treatment with a form of medication to reduce the expected number of cases of a defined endpoint by one. ...

The treatment of 100 patients for six years would prevent four deaths of the disease and seven non-fatal myocardial infarcts. A myocardial infarction occurs when an atherosclerotic plaque slowly builds up in the inner lining of a coronary artery and then suddenly ruptures, totally occluding the artery and preventing blood flow downstream. ...

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. Cardiology is the branch of medicine dealing with disorders of the heart and blood vessels. ... Evidence-based medicine is a medical movement based upon the application of the scientific method to medical practice, including long-established existing medical traditions not yet subjected to adequate scientific scrutiny. ...

References

1. 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
2. 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
3. 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