Simvastatin coronary artery disease

Simvastatin is also used in combination with nicotinic acid. It is found to be the most useful drug combination for the treatment of dyslipidemias associated with coronary artery disease. It is particularly effective in normalizing the lipid profiles of patients with familial combined dyslipidemia. 

The Heart Protection Study randomly allocated 20,536 adults with coronary artery disease, occlusive disease of noncoronary arteries, or diabetes to simvastatin (40 mg) or placebo. In a subgroup analysis of more than 1300 patients with plasma creatinine concentration between 1.2mg/dL and 2.3mg/dL (110 and 200 pmol/L), there were fewer major vascular events in the simvastatin group. 

Compare the patient with those in the study (similar disease state and stage, similar baseline characteristics). This assessment should ensure that the population studied has a similar disease state and prognostic factors as the patient now being treated. For instance, the results of a trial assessing the mortality benefit of simvastatin in dyslipidemic men with known coronary artery disease would not likely apply to dyslipidemic women with no other coronary risk factors. 

Shepherd J, Hunninghake DB, Barter P, McKenney JM, Hutchinson HG. GuideUnes for lowering lipids to reduce coronary artery disease risk a comparison of rosuvastatin with atorvastatin, pravastatin, and simvastatin for achieving lipid-lowering goals. Am. J. Cardiol 2003 91 (5A Suppl S) 11C-17C. 

Atherosclerotic cardiovascular disease HMG co-A reductase inhibitors Lovastatin Pravastatin Simvastatin Primary and secondary prevention of coronary heart disease (CHD) reduced hospitalizations, percutaneous transluminal coronary angioplasties (PTCA), and coronary artery bypass graft surgeries (CABG) reduced all-cause mortality 4S AFCAPS CARE LIPID WOSCOPS >30,000 7,8... 

Combination therapy with niacin and a statin has also been shown to produce clinical and angiographic benefits. Brown et al. (56) evaluated the effects of simvastatin in combination with niacin on patients with documented coronary disease in the HATS trial and demonstrated a significant reduction in nonfatal MI or death from cardiovascular causes compared to placebo, albeit with a relatively small number of patients. In the treatment arm, HDL cholesterol increased by 26% over the three years of treatment and was also associated with a slight regression (0.4%) in coronary mean percent stenosis in the proximal arteries by invasive arteriography the placebo arm experienced a 3.9% increase in stenoses. 

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