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European Heart Journal 1998 19(10):1531-1537; doi:10.1053/euhj.1998.1191
Copyright © 1998 by the European Society of Cardiology.
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Differences in the treatment of coronary heart disease between countries as revealed in the Scandinavian Simvastatin Survival Study (4S)

O. Faergemana, J. Kjekshusb, T. Cookc, K. Pyöräläd, L. Wilhelmsene, G. Thorgeirssonf and T.R. Pederseng

a Department of Medicine and Cardiology, Aarhus Amtssygehus, Aarhus, Denmark
b Department of Medicine, Rikhospitalet, Oslo, Norway
c Merck Research Laboratories, Rahway, New Jersey, U.S.A.
d Department of Internal Medicine, University of Kuopio, Kuopio, Finland
e Section of Preventive Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
f Landspitalinn University Hospital, Reykjavik, Iceland
g Medical Clinic, Aker Hospital, Oslo, Norway

accepted June 3, 1998

Aim To assess differences in treatment of ischaemic heart disease in the Scandinavian countries.

Methods and Results The Scandinavian Simvastatin 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 given placebo. Apart from this main result, the 4S provided detailed information on rates of death and other manifestations of coronary heart disease, as well as on use of non-lipid forms of therapy. There were substantial differences in 4S placebo group rates of mortality, coronary deaths and major coronary events between countries. Surgical and medical therapy varied importantly between countries.

Conclusions Major inter-country differences in rates of death and myocardial infarction in patients with coronary heart disease were likely to be due to a composite of differences in baseline characteristics including smoking. They occurred in a setting of very uneven exploitation of the potential for improving survival of patients with ischaemic heart disease.

Key Words: Coronary heart disease • cholesterol • medical technology • smoking • beta-blockade • calcium channel blockers • revascularization

Correspondence:Ole Faergeman, MD, Department of Medicine and Cardiology, Aarhus Amtssygehus University Hospital, DK-8000 Aarhus C, Denmark.


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