CHOLESTEROL-LOWERING AFTER PARTICIPATION IN THE SCANDINAVIAN SIMVASTATIN SURVIVAL STUDY (4S) IN FINLAND

Background Patient compliance is crucial for the effectiveness of prev entive medication. The aim of the study was to investigate changes in serum cholesterol levels and the use of cholesterol lowering drugs one year after the end of the Scandinavian Simvastatin Survival Study (4S ), a randomized secondary prevention study of coronary heart disease w ith simvastatin and placebo. Methods and results A questionnaire askin g the current use of cholesterol lowering drugs, most recent serum cho lesterol value and attitudes towards cholesterol lowering was sent to 785 surviving 4S participants in four 4S centres in Finland. The respo nse rate was 94%. The current use of cholesterol lowering drugs and th e reported mean serum cholesterol values were similar to the original simvastatin and placebo groups. In all, 74% (n = 546) reported that th ey had used cholesterol lowering drugs after the study, and 63% (n = 4 67) were currently using them, mostly simvastatin (96%) with an averag e dose of 14 (SD 5)mg.day(-1). Cholesterol lowering was considered to be 'very important' by 53% and 'important' by 37% of the respondents. The most frequent reasons for discontinuation were 'drug costs' (38%) and 'normal cholesterol values' (30%). The reported mean serum cholest erol levels were 5.1 (SD 1.0) and 5.7 (SD 1.1)mmol(-1) in the current cholesterol lowering drug users and non-users, respectively (P < 0.000 1). The in-trial treatment goal of serum cholesterol (less than or equ al to 5.2 mmol(-1)) was not met in 38% of the users and in 68% of the non-users of cholesterol lowering drugs. Conclusion One year post-tria l the original simvastatin and placebo groups of the 4S had become sim ilar with regard to the use of cholesterol lowering drugs and serum ch olesterol levels. The adherence to medication, however, still remained relatively high, but there was a shift toward lower doses, and conseq uently toward higher post-trial serum cholesterol levels.