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	Simvastatin has long-term survival benefit: heart disease & cancer examined
		Publication of the Scandinavian Simvastatin Survival Study (4S) in The Lancet in 19941 was early trial evidence of the benefits of 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors (statins) in the prevention of coronary events and in the reduction of all-cause mortality.
		During the double-blind period of the 4S, the survival curves for all-cause, cardiovascular, and coronary mortality in the simvastatin group and the placebo group began to diverge early and progressively until closure of the trial.
		The original simvastatin group could be expected to be at an increased risk of non-cardiovascular death during the extended follow-up because their survival improved during the trial through the reduction of cardiovascular deaths.
	www.natap.org /2004/HIV/083004_02.htm (1646 words)

	Scandinavian Simvastatin Survival Study - Wikipedia, the free encyclopedia
		The Scandinavian Simvastatin Survival Study (also known under the abbreviation 4S) is a multicenter clinical trial that was performed in 1990s in Scandinavia.
		The objective of the study was to assess effect of cholesterol-lowering drug called simvastatin on mortality and morbidity in group of 4444 patients with coronary heart disease, aged between 35 and 70 years.
		The 4S study turned out to be a milestone in cardiology and evidence-based medicine it was clearly proven that treatment with statins saved lives of patients with coronary heart disease.
	en.wikipedia.org /wiki/Scandinavian_Simvastatin_Survival_Study (373 words)

	American Heart Association '98 - Merck Simvastatin Symposium
		Simvastatin is a white to off-white, nonhygroscopic, crystalline powder that is practically insoluble in water, and freely soluble in chloroform, methanol and ethanol.
		In this multicenter, randomized, double-blind, placebo-controlled study, ZOCOR significantly reduced the risk of mortality by 30 percent (11.5 percent vs 8.2 percent, placebo vs ZOCOR); of CHD mortality by 42 percent (8.5 percent vs 5.0 percent); and of having a hospital-verified non-fatal myocardial infarction by 37 percent (19.6 percent vs 12.9 percent).
		Simvastatin is a lactone that is readily hydrolyzed in vivo to the corresponding beta-hydroxyacid, a potent inhibitor of HMG-CoA reductase.
	members.tripod.com /~APICENTER/AHA98-merck.html (6745 words)

	Zocor - Zocor Side Effects - Zocor Information - Canada Pharmacy - Canada Drugs
		Simvastatin reduced the risk of death by 30% (182 deaths in the simvastatin group vs 256 deaths in the placebo group).
		In one study in 404 hypercholesterolemic men and women with coronary heart disease, simvastatin monotherapy was shown to significantly slow the progression of coronary atherosclerosis as assessed by quantitative angiography and significantly reduce the development of both new lesions and new total occlusion.
		Simvastatin (5 to 80 mg/day) reduces the levels of total cholesterol (19 to 36%), LDL-cholesterol (26 to 47%), apolipoprotein B (19 to 38%), and triglycerides (12 to 24%), in patients with mild to severe hyperlipidemia (Fredrickson Types IIa and IIb).
	www.rxcarecanada.com /Zocor.asp?prodid=2185 (4321 words)

	4S
		In the placebo group 12% of patients died, in the simvastatin group 8%, a risk reduction of 30% (p = 0.0003) attributable to a 42% decrease in the risk of coronary death.
		Simvastatin significantly reduced the risk of major coronary events in all quartiles of baseline total, HDL and LDL cholesterol, by a similar amount in each quartile.
		Simvastatin use was associated with a 32% reduction in the total cost of hospitalisation compared to the use of placebo.
	www.incirculation.net /whatswhat/11093_11432.aspx (483 words)

	Reducing CHD in Diabetic Patients Using Simvastatin - February 15, 2000 - American Academy of Family Physicians
		The 4S study was a double-blind, randomized, prospective, placebo-controlled, multicenter trial of simvastatin therapy in patients with CHD carried out in 94 clinical centers throughout Scandinavia.
		Over the five years of observation, treatment with simvastatin reduced cardiovascular disease-related hospitalizations by 23 percent in patients with normal fasting glucose levels, by 30 percent in patients with impaired glucose tolerance and by 40 percent in patients with diabetes.
		Simvastatin therapy reduced the average cost of cardiovascular disease-related hospitalizations by $3,585 in patients with normal fasting glucose levels (this offset 60 percent of the cost of the simvastatin therapy), and by $4,478 in patients with impaired glucose tolerance (this offset 74 percent of the cost of simvastatin therapy).
	www.aafp.org /afp/20000215/tips/26.html (441 words)

	Zocor Side Effects, and Drug Interactions - Simvastatin - RxList Monographs
		In the pre-marketing controlled clinical studies and their open extensions (2,423 patients with mean duration of follow-up of approximately 18 months), 1.4% of patients were discontinued due to adverse experiences attributable to ZOCOR.
		In controlled clinical studies in which simvastatin was administered concomitantly with cholestyramine, no adverse reactions peculiar to this concomitant treatment were observed.
		Simvastatin is metabolized by CYP3A4 but has no CYP3A4 inhibitory activity; therefore it is not expected to affect the plasma concentrations of other drugs metabolized by CYP3A4.
	www.rxlist.com /cgi/generic/simva_ad.htm (1036 words)

	simvastatin - Ask.com Web Search
		Simvastatin (INN) (IPA: [ˈsɪmvəˌstætn]) is a hypolipidemic drug belonging to the class of pharmaceuticals called "statins".
		Simvastatin is a white to off-white, nonhygroscopic, crystalline powder that is practically insoluble in water, and freely soluble in...
		Simvastatin is used to reduce the total amounts of cholesterol, LDL (bad) cholesterol, triglycerides (another type of...
	search.ask.com /web?q=simvastatin (350 words)

	IngentaConnect Simvastatin: a review (Site not responding. Last check: 2007-11-03)
		The only important, although rare, adverse effect of simvastatin is myopathy, an effect shared by all members of the class; when severe, this can take the form of rhabdomyolysis, which may lead to acute renal failure.
		Simvastatin has been studied in two large outcome trials, the Scandinavian Simvastatin Survival Study (4S), and the Heart Protection Study (HPS), both of which demonstrated strikingly beneficial effects on a variety of cardiovascular outcomes, with minimal adverse effects.
		HPS showed that the beneficial effects of simvastatin were obtainable in a broad array of patients with, or at high risk of, coronary heart disease (CHD) in categories previously little studied, including women, the elderly, patients with diabetes without known CHD, and, perhaps most importantly, patients with LDL-C well below the UK population average.
	www.ingentaconnect.com /content/apl/eop/2004/00000005/00000012/art00016 (340 words)

	Scandinavian Simvastatin Survival Study - General Practice Notebook (Site not responding. Last check: 2007-11-03)
		The Scandinavian Simvastatin Survival Study followed 4444 patients with moderate hypercholesterolaemia (5.5-8.0 mM) who also had symptomatic coronary heart disease for a median time of 5.4 years.
		the relative risk of death in the simvastatin group was 0.70 (p=0.0003)
		6 year survival was 91.3% in the simvastatin group against 87.6% in the placebo group
	www.gpnotebook.co.uk /cache/1657798706.htm (205 words)

	Data management techniques applied to the Scandinavian simvastatin survival study (4S) mega-trial Drug Information ...
		The primary objective was to investigate the effect of long-term treatment with the serum lipid-lowering agent simvastatin (Zocor) on mortality in patients with ischemic heart disease.
		Secondary objectives were to assess the effects of simvastatin on the incidence of nonfatal major coronary events, other atherosclerotic events and hospitalization, and to assess the long-term safety of the drug.
		The decision to stop the study was made following the results from the third interim analysis presented at the data safety monitoring board meeting held on May 24, 1994 which predicted that the requisite number of deaths would be reached by early August 1994.
	www.findarticles.com /p/articles/mi_qa3899/is_199901/ai_n8838513 (1004 words)

	Simvastatin: Preventing MI
		Simvastatin is the first cholesterol-lowering drug indicated for use with diet to prevent heart attacks in patients with hypercholesterolemia and coronary artery disease (CAD), including those patients who have had a heart attack or have undergone coronary bypass surgery.
		Simvastatin 20 to 40 mg/day reduced mean total cholesterol by 25% and low-density lipoprotein (LDL) cholesterol by 35%, and elevated high- density lipoprotein (HDL) cholesterol by 8%.
		Simvastatin also reduced the risk of undergoing myocardial revascularization procedures by 37% and caused a slight reduction in fatal and nonfatal cerebrovascular events.
	pharminfo.8media.org /pubs/msb/simvast.html (516 words)

	Geriatric Times...Statin Adverse Effects: Implications for the Elderly
		While patients at high risk for cardiovascular disease receive mortality benefit from statins in studies predominating in middle-aged men (Scandinavian Simvastatin Survival Study Group, 1994), no trend toward survival benefit is seen in elderly patients at high risk for cardiovascular disease (Shepherd et al., 2002).
		Indeed, a number of studies show that even modest reductions in cognition in the elderly are linked to increased mortality, even when the reductions remain within the nondemented range, and even when other health factors have been controlled for (Bassuk et al., 2000; Frisoni et al., 1999; Korten et al., 1999; Smits et al., 1999).
		Scandinavian Simvastatin Survival Study Group (1994), Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
	www.geriatrictimes.com /g040618.html (2826 words)

	Lipids Online Slides: simvastatin, 4S, diabetes, LIPID, CARE
		In this analysis, simvastatin therapy was associated with a 42% reduction in major coronary events such as fatal and nonfatal MI, and there was also a significant 48% reduction in revascularizations.
		In this analysis, simvastatin therapy was associated with significant reductions in all four major endpoints: major coronary events, revascularizations, total mortality, and CHD mortality.
		In an economic analysis of the effect of simvastatin on hospital stay in 4S, there was a 55% reduction with simvastatin therapy in patients with diabetes (using the ADA criterion), a 38% reduction in patients with impaired fasting glucose, and a 28% reduction in patients with normal fasting glucose.
	www.lipidsonline.org /slides/slide01.cfm?q=simvastatin (1093 words)

	Lipid Intervention Trials Diabetes Overview Lipid Treatment Controls Chd Lipid Therapy Checks Cvd (Site not responding. Last check: 2007-11-03)
		The Helsinki Heart Study, a primary intervention trial that examined the effects of treating hyperlipidemia with gemfibrozil in middle-aged men, found a reduction in coronary events; however, numbers were too small to reach significance in the diabetic subgroup.
		The Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study is examining the effects of micronized fenofibrate on total and fatal CAD events in men and women with type 2 diabetes, some of whom are known to have coronary disease.
		The Lipids in Diabetes Study (LDS) is examining the effects of various pairs of placebo, micronized fenofibrate, and cervistatin on plasma lipids in 4,000 patients with type 2 diabetes and normal/near-normal lipid levels.
	www.coronaryheartdisease.org /lipid-intervension-trials-diabates.htm (326 words)

	Scandinavian Simvastatin Survival Study (4S)
		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).
		Furthermore, a 34% reduction in non-fatal heart attacks was observed, as was a 42% reduction in deaths from heart attacks.
		The difference in survival between the placebo and treatment groups was apparent by the second year of the study.
	www.lipid-clinic.com /4S.html (166 words)

	Statins effective in long term, Nordic study suggests
		The Scandinavian Simvastatin Survival Study (4S) led by Timo Strandberg (University of Helsinki, Finland) and colleagues was launched in 1989.
		The long-term follow-up results compare the initial 2221 patients who have had simvastatin for 10 years, compared with the 2223 patients who initially received placebo (and only started statins 5 years ago after the 4S trial was completed and the results of statin benefit became known).
		Dr Strandberg comments: "The main finding of this 10-year follow-up study of the participants of 4S was that the survival benefit of patients allocated simvastatin compared with those allocated placebo that accrued during the double-blind trial period persisted during follow-up.
	www.eurekalert.org /pub_releases/2004-08/l-sei082504.php (474 words)

	The International Network of Cholesterol Skeptics
		We are questioning the wisdom of recommending statin treatment for a large segment of the world’s population simply because they have elevated lipid levels or are assumed to be at increased risk for coronary events because of the presence of other risk markers.
		Sir-The authors of the Heart Protection Study state that its size provides "considerable reassurance" that long term simvastatin therapy to lower cholesterol is unlikely to induce cancer.1 However, we believe that an important aspect of this potentially serious problem has been overlooked.
		It is therefore somewhat alarming that in both simvastatin trials, non-melanoma skin cancer was seen more often in the treatment groups.1 2 While the increased incidence was not statistically significant in the HPS trial, when results from both simvastatin studies are combined, non-melanoma skin cancer was significantly higher (p=0.028) in patients receiving simvastatin.
	www.thincs.org /unpublic.LancetHPS.htm (868 words)

	Today in Cardiology: FDA approves simvastatin for stroke
		The Scandanavian Simvastatin Survival Study showed drug is effective in reducing TIA risk.
		In the 4S trial, patients treated with simvastatin, either 20 mg or 40 mg daily, experienced 42% fewer deaths from heart disease, resulting in 30% fewer deaths from any cause.
		Therapy with simvastatin reduced the risk of new or worsened chest pain by 26% and reduced carotid bruits by 48%.
	www.cardiologytoday.com /199805/fda.asp (389 words)

	Study Shows Zocor Reduces Risk Of Stroke
		While 4S firmly established that lowering cholesterol with simvastatin reduced the risk of heart attacks and death, it was only recently determined that Zocor therapy also substantially reduced the risk of stroke, the third leading cause of death in the world.
		The study was conducted at 94 clinical centers in Denmark, Finland, Iceland, Norway and Sweden.
		The Framingham Study, for example, found that after suffering a stroke, 31 percent of patients require assistance, 20 percent need help walking and 71 percent are vocationally impaired after seven years.
	www.docguide.com /dg.nsf/PrintPrint/0E7CD0915DAF1C768525659F00507869 (908 words)

	bmj.com Rapid Responses for Miettinen et al., 316 (7138) 1127-1130 (Site not responding. Last check: 2007-11-03)
		Editor Miettinen and colleagues present an interesting analysis of Finnish patients in the Scandinavian Simvastatin Survival Study, identifying a subgroup with high cholestanol ratios who gained no benefit from statin treatment (1).
		It would also be of interest to know whether the balance between cholesterol absorption and synthesis as measured by the cholestanol ratio accounts for a major part of the large variability between patients in the response of serum cholesterol to simvastatin.
		Baseline serum cholestanol as predictor of recurrent coronary events in subgroup of Scandinavian simvastatin survival study.
	bmj.bmjjournals.com /cgi/eletters/316/7138/1127 (336 words)

	Lipids and Cadiovascular Disease.
		Total mortality was decreased significantly in the treated group (8% vs. 12%), CVD deaths were decreased in the simvastatin group whilst there no increase in deaths from other causes particularly violent deaths.
		Simvastatin also reduced the incidence of a further AMI, angioplasty or CABG.
		A cost effective study based on the 4S study estimated that simvastatin treatment of men aged 55-64 who suffered a MI would cost £6000 per life year saved, whereas it would cost £361 000 life year saved for women aged 45-54 with angina.
	www.abersychan.demon.co.uk /lipids.htm (656 words)

	NHLBI: Benefits of Cholesterol Lowering (Site not responding. Last check: 2007-11-03)
		The study found that in those receiving statin, deaths from heart disease were reduced by 42 percent, the chance of having a nonfatal heart attack was reduced by 37 percent, and the need for bypass surgery or angioplasty was reduced by 37 percent.
		This study reported that even in patients with seemingly normal cholesterol levels (average of 209 mg/dL), cholesterol lowering with a statin drug lowered the risk of having another heart attack or dying by 24 percent.
		A study published in 1998, the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study, examined the effects of cholesterol lowering in people with CHD (those who had already experienced a heart attack or had been hospitalized for angina) and who had relatively average cholesterol levels.
	www.nhlbi.nih.gov /chd/why4.htm (818 words)

	Reduction of Cardiovascular Events by Simvastatin in Nondiabetic Coronary Heart Disease Patients With and Without the ...
		The DECODE Study Group: Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in non-diabetic European men and women.
		Scandinavian Simvastatin Survival Study Group: Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).
		Scandinavian Simvastatin Survival Study Group: Baseline serum cholesterol and treatment effect in the Scandinavian Simvastatin Survival Study (4S).
	care.diabetesjournals.org /cgi/content/full/27/7/1735 (3431 words)

	We are recommended to do liver function tests before and after starting a statin is there any evidence?
		They searched their sources for the primary studies that have contributed to current guidelines on liver function tests, and to find data on reported incidences of hepatitis.
		Scandinavian Simvastatin Survival Study Group, Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study, The Lancet, 1994, 344, 8934, 1383-1389.
		Behounek BD et al, A multinational study of the effects of low-dose pravastatin in patients with non-insulin-dependent diabetes mellitus and hypercholestolaemia, Clin Cardiol 1994; 17 (10): 558-562.
	www.tripdatabase.com /spider.html?itemid=145211 (1165 words)

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