Effect of Simvastatin on Ischemic Signs and Symptoms in the Scandinavian Simvastatin Survival Study (4S) Terje R. Pedersen, MD, John Kjekshus, MD, Kalevi.

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Presentation transcript:

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, % 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, % 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, % 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, % 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 AnginapectorisIntermittentclaudication 1 bruit  1 bruitCarotidbruitFemoralbruit P< 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

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