| Authors |
Pyorala
K, Ballantyne CM, Gumbiner B, Lee MW, Shah A, Davies MJ, Mitchel YB, Pedersen
TR, Kjekshus J; Scandinavian Simvastatin Survival Study (4S).
|
| Abstract |
OBJECTIVE:
To assess the effect of simvastatin treatment on the risk of cardiovascular
events in nondiabetic patients with coronary heart disease (CHD) with and
without the metabolic syndrome, as defined by the National Cholesterol Education
Program (NCEP) Adult Treatment Panel III (ATP-III). RESEARCH DESIGN AND
METHODS: Subgroup analyses were performed on data from 3933 nondiabetic
patients with clinically established CHD, serum total cholesterol level
5.5-8.0 mmol/l, and serum triglyceride level <or=2.5 mmol/l who were
participating in the Scandinavian Simvastatin Survival Study (4S), a randomized,
placebo-controlled trial. End points were total mortality, coronary mortality,
major CHD event, myocardial revascularization, any CHD event, stroke, and
any atherosclerotic event. RESULTS: Over the 5.4-year median follow-up period,
simvastatin produced similar changes in serum lipid levels in 893 patients
with the metabolic syndrome and in 3040 patients without the metabolic syndrome.
The relative risks of main end points in simvastatin-treated patients compared
with placebo-treated patients with the metabolic syndrome were as follows:
total mortality 0.54 (95% CI 0.36-0.82), coronary mortality 0.39 (0.23-0.65),
major CHD event 0.59 (0.45-0.77), and any atherosclerotic event 0.69 (0.56-0.84).
The corresponding RRs in patients without the metabolic syndrome were 0.72
(0.56-0.91), 0.62 (0.45-0.84), 0.71 (0.61-0.82), and 0.76 (0.68-0.85). CONCLUSIONS:
Nondiabetic CHD patients with or without the metabolic syndrome realize
from simvastatin treatment a similar, substantial relative reduction in
the risk of cardiovascular events. The absolute benefit may be greater in
patients with the metabolic syndrome because they are at a higher absolute
risk.
|
