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| {{SI}}
| | #Redirect [[4S Trial]] |
| {{WikiDoc Cardiology Network Infobox}}
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| {{CMG}}
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| '''The Scandinavian Simvastatin Survival Study''' (also known under the abbreviation '''4S''') is a multicenter [[clinical trial]] that was performed in 1990s in Scandinavia.
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| 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.
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| The patients exhibited moderate [[hypercholesterolemia]], between 5.5 and 8.0 mmol/l.
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| The trial showed that treatment of patients suffering from coronary heart disease with simvastatin had a lowering effect on mortality and morbidity.
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| 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 CHD-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.
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| The treatment of 100 patients for six years would prevent four deaths of the disease and seven non-fatal [[Myocardial infarction|myocardial infarcts]].
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| 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.
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| However, it should be noted that no trial of statin in primary prevention (people without symptomatic coronary artery disease or diabetes) has shown an overall health benefit.
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| ===References===
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| # 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
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| # 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
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| # 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
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| [[Category:Epidemiology]]
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| [[Category:Cardiology]]
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| [[Category:Statins]]
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| [[Category:Clinical trials]]
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