Lipoprotein Changes and Reduction in the Incidence of Major Coronary Heart Disease Events in the Scandinavian Simvastatin Survival Study (4S)

Pedersen, Terje R.; Olsson, Anders; F˦rgeman, O.; Kjekshus, John; Wedel, Hans; Kjekshus, K.; Wilhelmsen, Lars; Haghfelt, Torben; Þorgeirsson, Guðmundur; Pyorl, Kalevi; Miettinen, T. A.; Christophersen, Bjørn O.; Tobert, Jonathan A.; Musliner, Thomas; Cook, Thomas J.

doi:10.1016/j.atherosclerosissup.2004.08.030

Cited by 62 publications

(57 citation statements)

References 19 publications

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“…Further analyses suggested that the beneficial effect in 4S was determined mainly by the magnitude of the change in LDL cholesterol. There was shown a continuing CHD risk reduction down to an LDL cholesterol level of about 80 mg/ dL [25]. Although HDL cholesterol provided additional information to total cholesterol when used as the primary lipid in the statistical model examined, when LDL cholesterol was used as the primary lipoprotein component, none of the other lipids or apolipoproteins improved on the prediction of CHD in 4S.…”

Section: Data From Statin Trialsmentioning

confidence: 95%

Goals of statin therapy: Three viewpoints

Thompson

Packard

Stone

2002

Curr Atheroscler Rep

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The "lipid hypothesis" is now universally recognized as a law. Few issues in medicine are as completely resolved as the question of whether reducing serum cholesterol increases longevity. However, there are a few questions that remain, and the most important uncertainty is to what extent cholesterol should be reduced. The medical community, in partnership with government and industry, has contributed many excellent trials demonstrating the effects in patients with elevated cholesterol (above the mean). Where should our goal of therapy be? Until data is available from several large, ongoing trials, we do not have a final answer. We asked three investigators, Drs. Gilbert Thompson, Christopher Packard, and Neil Stone, who have all been integrally involved in the accumulation of our present database, to argue three different possible answers.

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Section: Data From Statin Trialsmentioning

confidence: 95%

Goals of statin therapy: Three viewpoints

Thompson

Packard

Stone

2002

Curr Atheroscler Rep

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“…Furthermore, CV risk factors were greatly improved (Table 1). Most strikingly, LDL cholesterol reductions ranged from approximately 9% to 25%, which is significant because each 1% reduction in LDL cholesterol reduces the risk of major coronary events by 1.7% [32]. Finally, preliminary evidence exists that supports multicomponent interventions, including vegetarian diet, exercise, and stress management, possibly improving quality of life [18••].…”

Section: The Effect Of Predominantly Plant-based Diets On Obesity Andmentioning

confidence: 98%

Plant-based dietary patterns in the control of obesity and cardiovascular risk

Dewell

Ornish²

2007

Curr Cardio Risk Rep

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Obesity and cardiovascular disease are uncommon in people consuming plant-based diets. In contrast, overweight and obesity are surging in US children and adults, increasing their risk for cardiovascular disease and diabetes. Plant-based diets are primarily comprised of whole plant foods that are rich in fiber and several beneficial phytochemicals and low to moderate in fat. Plant-based dietary patterns have been shown to reduce body weight and cardiovascular risk factors in adults, children, and adolescents. Well-planned plant-based diets are nutritionally adequate, well-accepted, and sustainable for the long term and represent an effective strategy in the control of obesity and cardiovascular disease risk.

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“…However, several studies, including the 4S (Scandinavian Simvastatin Survival Study) and MRFIT (Muliple Risk Factor Intervention Trial) studies, have reported that a curvilinear relationship exists between CHD risk and LDL cholesterol levels, implying that additional, but more modest, reductions in CHD rates occur at lower baseline, or lower "on treatment," LDL cholesterol levels [6,7]. More recently, the AFCAPS/TexCAPS study, a primary prevention trial that examined CHD incidence in healthy subjects with baseline average LDL cholesterol levels of 150 mg/dL, observed no threshold for CHD benefit within the range of LDL cholesterol levels (90 to 235 mg/ dL) achieved with lipid-lowering therapy [8].…”

Section: Introductionmentioning

confidence: 96%