Statins (HMG-CoA reductase inhibitors), a class of drugs that block production of cholesterol in the liver, lower total cholesterol and LDL and are also associated with cardiovascular benefits, are effective in the long term, conclude authors of a study in this week’s issue of THE LANCET.
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.