| Question: You
have just recommended that a 65yo male post-MI with an averaged LDL (2 measurements over 2
weeks) of 160mg/dL be started on simvastatin 10mg po qd. The physician asks you what the
basis for your recommendation is. Based on your knowledge of landmark secondary prevention
trials with HMG-CoA reductase inhibitors please defend your recommendation by briefly
describing the trial (of your choice) in terms of purpose/subjects/design/results and your
conclusion.
Answer:
The 4S trial was a randomized, double-blind, placebo controlled trial with over 4,000
patients (men and women) that had CHD (as does this patient). It was designed to study the
effect of simvastatin on this patient population in terms of CHD morbidity/mortality and
total mortality. Results showed a highly statistically significant reduction (greater than
30%) in terms of CHD morbidity/mortality and total mortality. Based on the 4S trial this
patient (fits study population criteria) is a candidate for cholesterol reduction in order
to reduce subsequent coronary events and total mortality. |
