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Simvastatin is used as an adjunct to nondrug therapies e. Several clinical trials designed to evaluate the benefits of simvastatin in patients with established CHD have reported improvements in https://www.healthline.com the risk of cardiovascular events, as evidenced by reductions in the risks of total mortality and nonfatal coronary events. The reduction in the combined coronary events nonfatal MI and revascularization procedures reported in the 4S trial also was observed in women, geriatric patients 65 years of age and older, and in patients with diabetes mellitus. Unlike some prior studies of cholesterol-lowering therapy, an increased risk of death from noncardiovascular causes was not observed in patients receiving simvastatin therapy in this study. In the Heart Protection Study HPS, therapy with simvastatin 40 mg daily in over 20, patients with CHD, history or stroke or other cerebrovascular disease, other occlusive arterial disease e. While a favorable trend toward reduction of major cardiovascular events was observed in this study, it is possible that more intensive therapy is required immediately after the onset of ACS during the period of greatest clinical instability to achieve a more rapid clinical benefit. Individual patient response may vary in clinical practice. If combination therapy is necessary, selection of the nonstatin drug should be based on the risk and benefit profile i. The addition of extended-release niacin to existing simvastatin-based therapy, however, did increase the risk of adverse effects e.

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