Document Detail

Risk factors for a major coronary event after myocardial infarction in the Scandinavian Simvastatin Survival Study (4S). Impact of predicted risk on the benefit of cholesterol-lowering treatment.
MedLine Citation:
PMID:  11428852     Owner:  NLM     Status:  MEDLINE    
AIMS: To analyse (1) the prognostic importance of clinical findings and lipids in patients with a previous myocardial infarction and (2) the relative and absolute benefit of simvastatin in patients at low, medium and high predicted risk. METHODS: The 4S was a double-blind, randomized, clinical trial of long-term treatment with simvastatin or matching placebo in patients with myocardial infarction or angina pectoris, serum total cholesterol 5.5-8.0 mmol x l(-1), and serum triglycerides <or=2.5 mmol x l(-1). The present study only deals with those 3525 patients who had a previous myocardial infarction. End-points comprised coronary death, definite and probable hospital verified myocardial infarction, and resuscitated cardiac arrest. Because there were few women the primary analyses were performed among men. RESULTS: A Cox model analysis in the placebo group identified the following independent predictors of coronary events: a history of hypertension (P=0.023), diabetes (P=0.0001), smoking after the myocardial infarction (P=0.010), total cholesterol (P=0.020), and HDL cholesterol (P=0.062). The relative reduction of risk by simvastatin treatment in patients at low, medium and high predicted risk was 38%, 39% and 42%, respectively, but the corresponding absolute benefit per 100 patients treated for 6 years increased from 7.9 to 16.2. CONCLUSION: In addition to serum lipids, clinical variables contributed significantly to prediction. The relative benefit from simvastatin treatment was independent of predicted risk, but the absolute benefit increased from low to high risk.
L Wilhelmsen; K Pyörälä; H Wedel; T Cook; T Pedersen; J Kjekshus
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  European heart journal     Volume:  22     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-06-28     Completed Date:  2001-09-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1119-27     Citation Subset:  IM    
Copyright Information:
Copyright 2001 The European Society of Cardiology.
Institute of Heart and Lung Diseases, Göteborg University, Göteborg, Sweden.
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MeSH Terms
Anticholesteremic Agents / therapeutic use*
Cholesterol / blood*
Coronary Disease / epidemiology*
Diabetes Mellitus / epidemiology
Double-Blind Method
Hypercholesterolemia / drug therapy*,  epidemiology
Hypertension / epidemiology
Middle Aged
Myocardial Infarction / blood,  drug therapy*,  epidemiology
Proportional Hazards Models
Risk Assessment
Risk Factors
Simvastatin / therapeutic use*
Smoking / epidemiology
Time Factors
Reg. No./Substance:
0/Anticholesteremic Agents; 57-88-5/Cholesterol; 79902-63-9/Simvastatin
Comment In:
Eur Heart J. 2001 Jul;22(13):1065-6   [PMID:  11428844 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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