Scandinavian Simvastatin Survival Study (4S)
4S Group. Lancet 1994 Nov 19;344(8934):1383-9.
4S Group. Lancet. 1995;345:1274-1275.
4S is a study of 4,444 patients with known cardiovascular disease and an average total cholesterol of 261 mg/dL. This study involved men (81%) and women (19%) aged 35 to 70 years who were given either simvastatin (Zocor) 20 mg/day or placebo (on follow-up visits, the dose may have been decreased or increased to either 10 mg or 40 mg to achieve a total cholesterol between 116 and 201 mg/dL). The average follow-up was 5.4 years.
Simvastatin treatment produced the following lipid changes:
Total Cholesterol reduced 25%
LDL (bad lipid) reduced 35%
HDL (good lipid) increased 8%
Treatment with simvastatin resulted in a 30% reduction in deaths from any cause. Furthermore, a 34% reduction in non-fatal heart attacks was observed, as was a 42% reduction in deaths from heart attacks. Age made no difference, as men and women over the age of 65 had possibly more survival benefit from being on simvastatin. The difference in survival between the placebo and treatment groups was apparent by the second year of the study.
4S: Improving lipid levels in people with heart disease and above average cholesterol levels.
