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Titolo:
RANDOMIZED TRIAL OF CHOLESTEROL-LOWERING IN 4444 PATIENTS WITH CORONARY-HEART-DISEASE - THE SCANDINAVIAN SIMVASTATIN SURVIVAL STUDY (4S)
Autore:
PEDERSEN TR; KJEKSHUS J; BERG K; HAGHFELT T; FAERGEMAN O; THORGEIRSSON G; PYORALA K; MIETTINEN T; WILHELMSEN L; OLSSON AG; WEDEL H; KRISTIANSON K; THOMSEN H; NORDERO E; THOMSEN B; LYNGBORG K; ANDERSEN GS; NIELSEN F; TALLERUPHUUS U; MCNAIR A; EGSTRUP K; SIMONSEN EH; SIMONSEN I; VEJBYCHRISTENSEN H; SOMMER L; EIDNER PO; KLARHOLT E; HENRIKSEN A; MELLEMGAARD K; LAUNBJERG J; FREUERGAARD P; NIELSEN L; MADSEN EB; IBSEN H; ANDERSEN U; ENEMARK H; HAARBO J; MARTINSEN B; DAHLSTROM CG; THYRRING L; THOMASSEN K; JENSEN G; RASMUSSEN SL; SKOV N; HANSEN KN; LARSEN ML; HAASTRUP B; HJAERE I; THUROE A; LETH A; MUNCH M; WORCK R; NIELSEN B; THORN AG; PEDERSENBJERGAARD O; FOURNAISE B; SIGURD B; ENK B; NIELSEN H; JACOBSEN L; SVENDSEN TL; HOEGHOLM A; MUNTER H; KAUFMANN P; HAUNSO S; GRANDE P; ERIKSEN C; NIELSEN HH; JURLANDER B; PINBORG T; PINDBORG J; TOST H; CHRISTIANSEN BD; OPPENHAGEN M; EGEDE F; HVIDT S; KJAERBY T; LEMMING L; KLAUSEN I; MIETTINEN TA; VANHANEN H; STRANDBERG TE; HOLTTA K; LUOMANMAKI H; PEKURI T; VUORINEN A; PASTERNACK A; OKSA H; SIITONEN L; RIMPI R; KESANIEMI YA; LILJA M; KORHONEN T; RANTALA A; RANTALA M; SAVOLAINEN M; UKKOLA O; LAINE L; VIRKKALA L; LEHTO S; MIETTINEN H; SALOKANNEL A; RAISANEN R; HOGNASON J; KRISTJANSDOTTIR H; THORVALDSDOTTIR G; SIGURDSSON G; SVERRISSON JT; HANSTEEN V; KJELSBERG F; BERGET K; PETTERSEN R; BALTO ER; HOLM T; GUNDERSEN T; ASLAKSEN B; ANDERSEN EH; TORSVIK H; FABER A; INDREBO T; OSE A; ROTERUD T; HOLSTLARSEN L; WAAGE K; HOLSTLARSEN E; HAEREM JW; AUKRUST P; TORP R; RISBERG K; MAUSETH K; GERDTS E; NYGARD O; HALLARAKER A; GRADEK G; VANGEN EM; SCHARTUMHANSEN H; REFSUM AM; LISTERUD S; GUNDERSRUD B; STENE AM; KLYKKEN B; AAKERVIK O; LORAAS A; FOSS PO; HAGA A; THORESEN L; DRIVENES A; LEM P; GABRIELSEN F; HESTAD S; RODE R; HAUG BK; SKJELVAN G; ELDORSEN E; YTREARNE K; RASMUSSEN K; MYHRE ESP; NERMOEN I; CHRISTIANSEN L; KARLSEN AS; WALBERG K; TJONNDAL HA; KULSENG B; ROKSETH R; NERGARD TV; ROE MO; TENSTAD O; LOFSNES IL; BERGSRUD U; MELBERG TH; VONBRANDIS C; BARVIK S; WOIE L; ABRAHAMSEN AM; AARSLAND T; SVANES H; NOER G; NORDLIE KE; HANEDALEN AE; JOHANSEN T; LARSEN CB; OSTHOLM E; OVERSKEID K; SANDVEI P; JOHANSEN A; SOGNEN E; AARSKOG D; DALE A; HEGRESTAD S; REIKVAM A; HAWKES L; HOFF S; TORJUSSEN T; NORVIK R; JORGENSEN C; HJERMANN I; LEREN P; NARVESTAD A; FAUSA D; GJESTVANG FT; NORDLAND B; BRUNMARK P; BIOKLUND H; BIOKLUND B; FORSBERG H; BERGSTROM B; LAAKSONEN I; VESTERMARK MB; MASCHER G; HAMMARSTROM E; TROSELL K; KARLSSON L; HALLSTROM L; STJERNA A; SLETTE MK; DIDERHOLM E; PBERGLUND K; LINDE B; AHLMARK G; SAETRE H; AHLBERG G; SUNDKVIST K; GUSTAFSSON PE; GUSTAFSSON E; NORRBY A; JAUP B; SVENSSON L; WIKLUND O; LINDEN T; BERGH CH; JONSTEG K; BONNIER B; LUNDIN Y; ROMANUS K; ULVENSTAM G; JOHANSSON S; WALLIN I; DUDAS K; ANDREASSON M; TORELUND G; SKARFORS E; RUTER G; AKESSON L; WAGNER F; LJUNGDAHL L; WAGNER V; RASMANIS G; EDHAG O; VOURISALO D; HJELMSELL H; WESLEY G; LUNDKVIST L; ANGMAN K; OLSSON A; SVENSON O; KUYLENSTIERNA J; FRISENETTEFICH K; BERGMAN E; STROMBLAD H; JENSEN S; JONSSON E; LEVIN C; ODEBERG H; BENGTSSON PO; HOLMESSON E; HEDSTRAND H; BOJO L; OBERG S; LEKSELL H; WERNER P; PERSSON S; SIMONSSON M; WIRENSTAM UB; MOBERG B; EKSTRAND AB; NICOL P; MALMROS B; SAAW J; ARCINI N; KOBOSKO J; ANEVIK IG; GYLAND F; LUNDH B; WENNERHOLM M; OLSSON C; KJELLBERG J; FABIANSON K; FRASER T; BERGKVIST I; BERGDAHL B; FLUUR C; WAJERSTAM S; SVENSSON KA; EKHOLM L; TOREBO E; RYBERG A; FRISELL JE; HEDMAN A; WALLRUP L; ANDERSEN G; SANDSTROM M; ALBERG K; FAGHER B; THULIN T; SVENSTAM I; BJURMAN A; SKOGLUND E; DAHL G; KJELLSTROM T; JUHLIN P; SJOOBOQUIST M; SJOGREN A; LOOGNA E; JANSSON T; FRIDEN J; NILSSON O; ANDERSSON PO; HENRIKSSON C; ELLSTROM J; BRODERSSON H; LUNDQUIST L; ASLUND M; BOMAN K; JANSSON JH; NORRFORS B; HOGLUND C; LUNDBLAD M; LILJEFORS I; WENNERSTROM L; PERZ I; LEIJD B; FALKENBERG C; BERGSTEN L; STROM S; ENGSTROM AC; EJDEBACK J; MALMBERG K; HOGSTROM S; STAHL L; MOLLER BH; LYCKSELL M; SODERSTROM M; HANSSON E; HALLEN C; STAKEBARG H; BORRETZEN J; HEDEN B; ANDERSSON K; JOHNSON O; BIRGANDER LS; ELANDER B; LIDELL C; ANDERSSON PE; MARKLUND E; DAHLEN M; RUCKER F; LOFQVIST M; WANNBERG B; LIM BH; LARSSON O; ANDERSSON G; HANSSON A; UCHTO M; GOWENIUS M; UGGELDAHL I; URSING D; HAMMARLUND P; NYMAN P; TSUPPUKA E; MALMBERG L; GORANSSON K; HASSELGREN P; INSBERG CM; PETTERSON S; AHRLIN A; LOVHEIM O; ANDERSSON LO; GRUNDSTROM I;
Indirizzi:
AKER HOSP,DEPT MED,CARDIOL SECT N-0514 OSLO NORWAY FREDERIKSBERG UNIV HOSP COPENHAGEN DENMARK HADERSLEV SYGEHUS HADERSLEV DENMARK HERNING SYGEHUS COPENHAGEN DENMARK HILLEROD SYGEHUS HILLEROD DENMARK HOLBAEK SYGEHUS HOLBAEK DENMARK HVIDVORE HOSP COPENHAGEN DENMARK ODENSE HOSP ODENSE DENMARK KAS GLOSTRUP COPENHAGEN DENMARK NYBORG SYGEHUS NYBORG DENMARK NYKOBING FALSTER SYGEHUS NYKOBING DENMARK NAESTVED SYGEHUS NAESTVED DENMARK RIGSHOSP DK-2100 COPENHAGEN DENMARK SVENDBORG SYGEHUS SVENDBORG DENMARK VEJLE SYGEHUS VEJLE DENMARK AARHUS AMSTSSYGEHUS AARHUS DENMARK HELSINKI UNIV HOSP HELSINKI FINLAND TAMPERE UNIV HOSP TAMPERE FINLAND OULU UNIV HOSP OULU FINLAND KUOPIO UNIV HOSP KUOPIO FINLAND LANDSPITALINN UNIV HOSP REYKJAVIK ICELAND REYKJAVIK CITY HOSP REYKJAVIK ICELAND SJUKRAHUSID AKUREYRI AKUREYRI ICELAND AUST AGDER SENTRALSJUKEHUS ARENDAL NORWAY BAERUM SYKEHUS SANDVIKA NORWAY GJOVIK FYLKESSJUKEHUSET GJOVIK NORWAY FYKESSJUKEHUSET HAUGESUND HAUGESUND NORWAY HAMAR SYKEHUS HAMAR NORWAY HAUKELAND HOSP BERGEN NORWAY HEDMARK SENTRALSYKEHUS ELVERUM NORWAY INNHERRED SYKEHUS LEVANGER NORWAY MOSS SYKEHUS MOSS NORWAY NORDLAND SENTRALSYKEHUS BODO NORWAY REG SYKEHUSET TROMSO TROMSO NORWAY REG HOSP TRONDHEIM TRONDHEIM NORWAY RINGERIKE SYKEHUS HONEFOSS NORWAY CENT HOSP ROGALAND STAVANGER NORWAY SANDEFJORD SYKEHUS SANDEFJORD NORWAY OSTFOLD SENTRALSYKEHUS AVD FREDRIKSTAAD NORWAY OSTFOLD SENTRALSYKEHUS AVD SARSPBORG NORWAY SOGN & FJORDANE SENTRALSYKEHUS FORDE NORWAY SPESIALISTSENTERET KRISTIANSAND NORWAY ULLEVAL HOSP OSLO NORWAY VEST AGDER SENTRALSYKEHUS KRISTIANSAND NORWAY ARVIKA SJUKHUS ARVIKA SWEDEN BODEN LULES SJUKHUS BODEN SWEDEN BOLLNAS SJUKHUS BOLLNAS SWEDEN ENKOPING LASARETT ENKOPING SWEDEN MALARSJUKHUSET ESKILSTUNA SWEDEN FALUN LASARETT FALUN SWEDEN GAVLE SJUKHUS GAVLE SWEDEN GLF LUNDBY SJUKHUS GOTHENBURG SWEDEN SAHLGRENS HOSP GOTHENBURG SWEDEN OSTRA HOSP GOTHENBURG SWEDEN HALMSTADS LANSSJUKHUS HALMSTAD SWEDEN HELSINGBORG LASARETT HELSINGBORG SWEDEN HUDDINGE SJUKHUS HUDDINGE SWEDEN HUDIKSVALLS SJUKHUS HUDIKSVALLS SWEDEN LANSSJUKHUSET RYHOV JONKOPING SWEDEN KARLSHAMN LANSLASARETT KARLSHAMN SWEDEN KARLSKRONA CENT LASARETT KARLSKRONA SWEDEN KARLSTAD CENT SJUKHUS KARLSTAD SWEDEN KRISTIANSTADS CENT SJUKHUS KRISTIANSTADS SWEDEN KRISTINEHAMN SJUKHUS KRISTINEHAMN SWEDEN KOPING LASARETT KOPING SWEDEN LANDSKRONA LASARETT LANDSKRONA SWEDEN LIDKOPING BASSJUKHUS LINKOPING SWEDEN LINDESBERG LASARETT LINDESBERG SWEDEN LINKOPING UNIV SJUKHUS LINKOPING SWEDEN LJUNGBY LASARETT LJUNGBY SWEDEN LUDVIKA LASARETT LUDVIKA SWEDEN UNIV SJUKHUSET LUND LUND SWEDEN LYCKSELE LASARETT LYCKSELE SWEDEN MALMO ALLAMNNA SJUKHUS MALMO SWEDEN NOORKOPING LASARETT NOORKOPING SWEDEN SANDVIKEN LASARETT SANDVIKEN SWEDEN SKELLEFTEA LASARETT SKELLEFTEA SWEDEN STOCKHOLM HEART CTR STOCKHOLM SWEDEN SABBATSBERG SJUKHUS STOCKHOLM SWEDEN ST GORAN SJUHHUS STOCKHOLM SWEDEN SKOVDE KARNSJUKHUS SKOVDE SWEDEN SUNDSVALLS SJUKHUS SUNDSVALL SWEDEN SAFFLE SJUKHUS SAFFLE SWEDEN TROLLHATAAN NAL TROLLHATAAN SWEDEN UMEA UNIV SJUKHUS UMEA SWEDEN UPPSALA AKAD SJUKHUS UPPSALA SWEDEN VISBY LASARETT VISBY SWEDEN VAXJO LASARETT VAXJO SWEDEN ANGELHOLM SJUKHUS ANGELHOLM SWEDEN OREBRO REG SJUKHUS OREBRO SWEDEN ORNSKOLDSVIK SJUKHUS ORNSKOLDSVIK SWEDEN
Titolo Testata:
Lancet
fascicolo: 8934, volume: 344, anno: 1994,
pagine: 1383 - 1389
SICI:
0140-6736(1994)344:8934<1383:RTOCI4>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
MYOCARDIAL-INFARCTION; ARTERY DISEASE; REGRESSION; MORTALITY; PREVENTION; HYPERCHOLESTEROLEMIA; ATHEROSCLEROSIS; PATHOGENESIS; PROGRESSION; MECHANISMS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
36
Recensione:
Indirizzi per estratti:
Citazione:
T.R. Pedersen et al., "RANDOMIZED TRIAL OF CHOLESTEROL-LOWERING IN 4444 PATIENTS WITH CORONARY-HEART-DISEASE - THE SCANDINAVIAN SIMVASTATIN SURVIVAL STUDY (4S)", Lancet, 344(8934), 1994, pp. 1383-1389

Abstract

Drug therapy for hypercholesterolaemia has remained controversial mainly because of insufficient clinical trial evidence for improved survival. The present trial was designed to evaluate the effect of cholesterol lowering with simvastatin on mortality and morbidity in patients with coronary heart disease (CHD). 4444 patients with angina pectoris or previous myocardial infarction and serum cholesterol 5.5-8.0 mmol/L on a lipid-lowering diet were randomised to double-blind treatment with simvastatin or placebo. Over the 54 years median follow-up period, simvastatin produced mean changes in total cholesterol, low-density-lipoprotein cholesterol, and high-density-lipoprotein cholesterol of -25%, -35%, and +80%, respectively, with few adverse effects. 256 patients(12%) in the placebo group died, compared with 182 (8%) in the simvastatin group. The relative risk of death in the simvastatin group was 0.70 (95% CI 0.58-0.85, p=0.0003). The 6-year probabilities of survivalin the placebo and simvastatin groups were 87.6% and 91.3%, respectively. There were 189 coronary deaths in the placebo group and 111 in the simvastatin group (relative risk 0.58, 95% CI 0.46-0.73), while noncardiovascular causes accounted for 49 and 46 deaths, respectively. 622patients (28%) in the placebo group and 431 (19%) in the simvastatin group had one or more major coronary events. The relative risk was 0.66 (95% CI 0.59-0.75, p<0.00001), and the respective probabilities of escaping such events were 70.5% and 79.6%. This risk was also significantly reduced in subgroups consisting of women and patients of both sexes aged 60 or more. Other benefits of treatment included a 37% reduction (p<0.00001) in the risk of undergoing myocardial revascularisation procedures. This study shows that long-term treatment with simvastatinis safe and improves survival in CHD patients,

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Documento generato il 28/11/20 alle ore 20:25:17