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The 4444-subject Scandinavian Simvastatin Survival Study (4S) showed that use of 20 mg to 40 mg of simvastatin daily reduced the risk of death, coronary death, MI, and need for coronary revascularization by 30% to 42% in patients with prior MI or angina pectoris and reduced total serum cholesterol from 5.5 to 8.0 mmol/l. (See JW Cardiology, Jan 95, p. 1, and Lancet 1994 Nov 19; 344:1383-9.) In this follow-up report, the team studied simvastatin's effects on subsets of patients; they divided the placebo and study groups into quartiles according to initial serum cholesterol levels.
The mean reduction in LDL cholesterol across each quartile was 32% to 37%. More important, however, the relative risk reduction was nearly identical in the four qua…