Table 3.

Effects of cholesterol lowering in secondary prevention of cardiovascular disease: prediction by computer program (based on Framingham study^10-12) compared with observed risk reductions in Scandinavian simvastatin survival study (4S)² and cholesterol and recurrent events trial (CARE)³

End point	Predicted reduction in relative risk (%)					Observed reduction (95% CI) in relative risk (%)
	Men			Women
	Non-smoker	Smoker		Non-smoker	Smoker
Scandinavian simvastatin survival study (4S)*
Myocardial infarction	50	39		58	47	33 non-fatal‡ 48 fatal
Death from coronary heart disease	55	49		62	58	42 (27 to 54)
Cholesterol and recurrent events trial (CARE)†
Myocardial infarction	41	32		49	39	23 (4 to 39)  non-fatal 37 (−5 to 62) fatal
Death from coronary heart disease	46	40		56	49	20 (−5 to 39)

^*4S trial included 4444 subjects (81% men, 26% current smokers) with angina or previous myocardial infarction. At entry, average age was 58 years in men and 60 years in women. Mean serum concentrations of total cholesterol and high density lipoprotein cholesterol were 6.75 mmol/l and 1.19 mmol/l respectively, and mean systolic blood pressure was 139 mm Hg. In the treatment arm simvastatin 10-40 mg produced an average reduction of 25% in total cholesterol concentration and an 8% increase in high density lipoprotein cholesterol concentration. 

^†CARE trial studied 4159 subjects with myocardial infarction (86% men, 21% active smokers). At entry, average age was 59 years. Mean baseline serum concentrations of total cholesterol and high density lipoprotein cholesterol were 5.40 mmol/l and 1.01 mmol/l respectively, and average systolic blood pressure was 129 mm Hg. In the treatment arm pravastatin 40 mg daily produced a 20% reduction in total cholesterol concentration and a 5% increase in high density lipoprotein cholesterol concentration. 

^‡Calculated from tables 2 and 3 of 4S report.²