DIFFERENCES IN THE TREATMENT OF CORONARY HEART-DISEASE BETWEEN COUNTRIES AS REVEALED IN THE SCANDINAVIAN SIMVASTATIN SURVIVAL STUDY (4S)

Aim To assess differences in treatment of ischaemic heart disease in t he Scandinavian countries. Methods and Results The Scandinavian Simvas tatin Survival Study (4S) lasted 5.4 years and showed that death rates in 4444 patients with coronary heart disease were 30% lower in those treated with simvastatin to lower serum cholesterol than in those give n placebo. Apart from this main result, the 4S provided detailed infor mation on rates of death and other manifestations of coronary heart di sease, as well as on use of non-lipid forms of therapy. There were sub stantial differences in 4S placebo group rates of mortality, coronary deaths and major coronary events between countries. Surgical and medic al therapy varied importantly between countries. Conclusions Major int er-country differences in rates of death and myocardial infarction in patients with coronary heart disease were likely to be due to a compos ite of differences in baseline characteristics including smoking. They occurred in a setting of very uneven exploitation of the potential fo r improving survival of patients with ischaemic heart disease.