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 study 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 therapy 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 treatment reduced cardiovascular mortality and coronary mortality by 36% and 43%, respectively. This trial was the first to demonstrate the advantage of lowering cholesterol in patients with coronary heart disease, and ushered in a revolution in treating heart disease 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 17% reduction in cardiovascular mortality and a 24% decrease in coronary mortality for 10-year statin use compared with 5-year use for people 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 12% reduction for long-term statin users was not stat
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
26-Aug-2004