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Effect of Simvastatin on Ischemic Signs and Symptoms in the Scandinavian Simvastatin Survival Study (4S)
Terje R. Pedersen, MD, John Kjekshus, MD, Kalevi Pyorala, MD, Anders G. Olsson, MD, Thomas J. Cook, MS, Thomas A. Musliner, MD, Jonathan A. Tobert, MD, PhD, and Torben Haghfelt, MD
The American Journal of Cardiology Vol. 81 February 1, 1998
Background
This analysis examines the effect of lipid intervention with simvastatin on noncoronary ischemic symptoms and signs during a median follow-up of 5.4 years.
This analysis also provides new information on the effect of simvastatin on angina pectoris.
The American Journal of Cardiology Vol. 81 February 1, 1998
Patients With a New or Worsening Angina Pectoris, Intermittent Claudication, or Bruits
The American Journal of Cardiology Vol. 81 February 1, 1998
Kaplan-Meier Curve for Patients in 4S with New or Worsening Intermittent Claudication
The American Journal of Cardiology Vol. 81 February 1, 1998
38% risk reduction
p=0.008
Kaplan-Meier Curve for Patients in 4S with New or Worsening Carotid Bruit
The American Journal of Cardiology Vol. 81 February 1, 1998
48% risk reduction
p=0.009
Kaplan-Meier Curve for Patients in 4S with New or Worsening Angina Pectoris
The American Journal of Cardiology Vol. 81 February 1, 1998
26% risk reduction
p<0.0001
Kaplan-Meier Curve for Patients in 4S with New or Worsening Cerebrovascular Events
The American Journal of Cardiology Vol. 81 February 1, 1998
28% risk reduction
p=0.033
Patients in 4S With Reduced Risk for Ischemic Signs and Symptoms
The American Journal of Cardiology Vol. 81 February 1, 1998
Angina
pectoris
Intermittent
claudication
> 1 bruit
Carotid
bruit
Femoral
bruit
P<0.0001
P=0.008
P=0.025
P=0.009
P=0.59
Stroke &
TIA
P=0.033
Conclusion
“This analysis provides evidence that effective cholesterol lowering with simvastatin 20 to 40 mg/day will retard progression of atherosclerosis in the arterial vasculature, not limited to the coronary circulation, resulting in less ischemic signs and symptoms.”
The American Journal of Cardiology Vol. 81 February 1, 1998