Effect of Simvastatin on Ischemic Signs and Symptoms in the Scandinavian Simvastatin Survival Study (4S)

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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
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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
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Patients With a New or Worsening Angina Pectoris,
Intermittent Claudication, or Bruits
The American Journal of Cardiology Vol. 81
February 1, 1998
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Kaplan-Meier Curve for Patients in 4S with New or
Worsening Intermittent Claudication
38 risk reduction p0.008
The American Journal of Cardiology Vol. 81
February 1, 1998
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Kaplan-Meier Curve for Patients in 4S with New or
Worsening Carotid Bruit
48 risk reduction p0.009
The American Journal of Cardiology Vol. 81
February 1, 1998
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Kaplan-Meier Curve for Patients in 4S with New or
Worsening Angina Pectoris
26 risk reduction plt0.0001
The American Journal of Cardiology Vol. 81
February 1, 1998
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Kaplan-Meier Curve for Patients in 4S with New or
Worsening Cerebrovascular Events
28 risk reduction p0.033
The American Journal of Cardiology Vol. 81
February 1, 1998
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Patients in 4S With Reduced Risk for Ischemic
Signs and Symptoms
P0.59
Plt0.0001
P0.033
P0.025
P0.008
P0.009
Angina pectoris
Intermittent claudication
gt 1 bruit
Carotid bruit
Femoral bruit
Stroke TIA
The American Journal of Cardiology Vol. 81
February 1, 1998
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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