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In 1994, the landscape of therapeutics was dramatically changed by the publication of the Scandinavian Simvastatin Survival Study (4S).1 After years of poor outcomes in managing cholesterol with fibrates, here was evidence that a new class of drug could reduce serious cardiovascular events, including death, in patients with ischaemic heart disease. Patients taking simvastatin had a 6-year probability of survival of 91% compared with 88% with placebo, giving an impressive number-needed-to-treat (NNT) of 27. Early primary prevention work with familial hypercholesterolaemia was stunning with significant benefits and a NNT of just 9 to prevent coronary heart disease and …
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