Statins effective in long term, nordic meditate suggests
Statins-a class of medicate s that lower cholesterol and are associated with cardiovascular benefits- are effective in the long term, conclude authors of a meditate in this week’s issue of THE LANCET (p 761).
Few data are available about the long-term effects of statins because previous trials have not extended beyond 5-6 years; however, the results of a Nordic meditate with a follow-up of 10 years has found that, in the long term, statins may decrease mortality rate and incidence of cancer. The Scandinavian Simvastatin Survival Study (4S) led by Timo Strandberg (University of Helsinki, Finland) and colleagues was launched in 1989. Patients from five participating countries - Denmark, Finland, Iceland, Norway and Sweden-were randomly assigned to 5 years of statin medical care with simvastatin or allocated a placebo. The results of the trial were published in THE LANCET 10 years ago (Lancet 1994; 344: 1383-89).
5-year follow-up showed that statins lowerd lipid fractions and cholesterol concentrations; furthermore, simvastatin a cure reduced cardiovascular mortality and coronary mortality by 36percent and 43percent, respectively. This trial was the first to demonstrate the advantage of lowering cholesterol in patients with coronary heart sickness, and ushered in a revolution in treating heart sickness more aggressively.
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).
Overall, there was a 17percent reduction in cardiovascular mortality and a 24percent decrease in coronary mortality for 10-year statin use compared with 5-year use for group given placebo in the original trial who later used statins. There was a suggestion that 10-year statin use was associated with a decreased incidence of cancer, although the 12percent reduction for long-term statin users was not statistically significant.
Dr Strandberg comments: “The main finding of this 10-year follow-up meditate 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. The reduction in the relative risk between the two original a cure groups was not unexpected, because open-label a cure with lipid-lowering medicate s (mostly statins) was given to most patients when the trial ended. After 3 years, more than 80percent of patients in both groups were using these medicate s. Nevertheless, the absolute differences in allcause,
cardiovascular, and coronary mortality achieved during the double-blind trial changed little during the 5-year extension of the follow-up”.
Contact: Dr Timo E Strandberg, Department of Medicine, University of Helsinki, PO Box 340, FIN–00029 HUS, Finland, T) +358 40 5969285; timo.strandberg@hus.fi
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