Scandinavian Simvastatin Survival Study

Last reviewed 02/2021

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.