This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

IHD (4S trial)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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. Patients were aged between 35 and 70 years.

  • the relative risk of death in the simvastatin group was 0.70 (p=0.0003)

  • the relative risk of a major coronary event in the simvastatin group was 0.66 (p<0.00001)

  • treatment reduced total cholesterol by 25% and lowered low density lipoprotein by 35%.

  • even in patients whose initial LDL cholesterol levels was below 4.4 mmol/l, simvastatin reduced the risk of a major coronary event by 35%.

  • 6 year survival was 91.3% in the simvastatin group against 87.6% in the placebo group

The treatment of 100 patients for six years would prevent four CHD deaths and seven non-fatal MIs.


  • the starting dose of simvastatin used in the 4S trial was simvastatin 20 mg per day. Thirty-seven per cent of patients had their dose increased to simvastatin 40mg per day after 6 months and 2 patients had their dose of simvastatin reduced to 10mg as per protocol


  1. Scandinavian Simvastatin Survival Study Group (1994). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344, 1383-1389.

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.


Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.