China
Africa
Explore chapters and articles related to this topic
Ailments and Diseases
Published in James Sherifi, General Practice Under the NHS, 2023
The other iconic study that became the staple of CV disease prevention in the mid-1990s was the Scandinavian Simvastatin Survival Study (4S).26 One of the first ‘megatrials,’ the precursors of meta-analysis, 4S, along with the West of Scotland Coronary Prevention Study (WOSCOPS27), demonstrated the link between blood lipids and cardiovascular events that formed the basis for the universal use of statins.
Management of the older patient after myocardial infarction
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Howard A. Cooper, Julio A. Panza, Wilbert S. Aronow
At 5.4-year median follow-up of 4444 men and women (1021 aged 65–70 years) with CAD and hypercholesterolemia in the Scandinavian Simvastatin Survival Study, compared with placebo, simvastatin 20–40 mg daily significantly decreased in patients aged 65–70 years total mortality by 34%, CAD mortality by 43%, major coronary events by 34%, nonfatal MI by 33%, any acute CAD-related endpoint by 33%, any atherosclerosis-related endpoint by 34%, and coronary revascularization procedures by 41% (Table 12.3). The absolute risk reduction for both all-cause mortality and CAD mortality was approximately twice as great in persons 65–70 years of age at study entry as in those younger than 65 years (50).
Lipid Subfraction Testing
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2015
A significant degree of “residual risk”28 exists in many patients after being treated with statins as evidenced in the major stain trials (Figure 4.4).34 Residual risk is found particularly in patients with insulin resistance and/or type 2 diabetes mellitus. In 2008,35 a “residual risk reduction initiative” was formed to focus specifically on a plan to treat the common atherogenic lipid abnormalities found in obese patients with metabolic syndrome and type II diabetes. Initially, in the earlier studies such as the Scandinavian Simvastatin Survival Study (4S), a 20% cardiovascular (CV) event rate was found in statin-treated patients. However, recent statin studies using high-dose statin therapy to achieve intensive LDL-C lowering have shown a further reduction in the risk of CHD. Nevertheless, there still exists an approximately 9% residual risk despite intensive LDL-C lowering.36 A persistent presence of atherogenic lipoproteins unrecognized by the traditional lipid panel is now felt to play a role in the residual risk. This situation has been described as “a treatment gap that can be recognized and closed with more intensive therapy only if the atherogenic particle is measured.”31
Prevalence of SLCO1B1 single nucleotide variations and their association with hypercholesterolaemia in hypercholesterolemic patients in Gauteng, South Africa
Published in Xenobiotica, 2021
Rene de Beer, Kim Outhoff, Alisa Phulukdaree, Prashilla Soma
The majority (64%) of the hypercholesterolemic patients in this study reported muscle-related adverse effects. Most (49%) reported their muscle pain as mild to moderate. Moderate severity indicates that muscle related symptoms only slightly reduce everyday activities such as experiencing difficulty in working, sleeping, performing household chores and climbing stairs. Reducing the statin dose may be a feasible treatment option while monitoring these patients’ CK levels (Kellick et al. 2014a). A total of 17% reported severe pain. Other studies have reported an overall prevalence of ∼30% of severe myalgia, myopathy and in some cases rhabdomyolysis. In these reports, the therapy included various statins, with myopathy observed in subjects on simvastatin and atorvastatin (Scandinavian Simvastatin Survival Study 1994; Jones et al. 1998; Group HPSC 2002; Ballantyne et al. 2003; Jones et al. 2003; Newman et al. 2003).
Current and emerging drug treatment strategies for peripheral arterial disease
Published in Expert Opinion on Pharmacotherapy, 2020
Hani Essa, Francesco Torella, Gregory Y. H. Lip
Statin therapy has the largest evidence base in PAD of the cholesterol-lowering medications [80,81]. The majority of the data in support of statin use in patients with PAD are derived from subgroup analyses of larger clinical trials. In 1998 a retrospective analysis of the 4 S (Scandinavian Simvastatin Survival Study) was the first to demonstrate that in CAD patients, treatment with simvastatin reduced the incidence or progressive intermittent claudication by 38% over a median follow up of 5.4 years [82]. Since then several trials have demonstrated the efficacy of a variety of statins. The first prospective trial demonstrating the efficacy of cholesterol reduction in PAD patients was in 2006. This was a prospective observation cohort study in 2420 PAD patients of which 581 had hypercholesterolemia. Following adjustment for risk factors they demonstrated an all-cause reduction in mortality (HR 0.46, P < 0.001) in patients with PAD treated with a variety of statins [83].
Outcome postponement as a potential patient centred measure of therapeutic benefit: examples in cardiovascular medicine
Published in Acta Cardiologica, 2020
Pierre Vladimir Ennezat, Thierry Le Jemtel, Shona Cosgrove, Jesper Hallas, Morten Rix Hansen
Long-term statin therapy moderately reduces specific vascular and all-cause deaths, especially in patients with average or high LDL-c levels [5]. Treatment with PCSK9 inhibitors is now being evaluated to reduce LDL-c levels beyond those reached with statin therapy. Of note, the Scandinavian Simvastatin Survival Study (4S) investigated simvastatin over 5.4 years of follow-up in 4444 patients with angina or history of MI and average LDL-c near 1.9 g/l, and resulted in a 30% RRR in mortality, a 3.3% ARR, and a NNT of 30 [6]. The survival gain of 27days obtained during the 6 years of 4S trial running time was the greatest amongst all statin trials [3]. Statins have been shown to postpone death by a median of only 3.1 and 4.2 days for primary and secondary prevention, within trial running time respectively [3].