Björck et al % 100 80 60 40 20 0 mmol/l 7.0 6.5 6.0 5.5 5.0 4.5 4.0 1994 1995 1996 1997 1998 1999 2000 2001 2002 Figure 1 Percent of men and women with lipid-lowering medication at 3-months follow-up after hospitalization for ﬁrst myocardial infarction during 1994–2002. these levels were achieved in 56% of the cases in men and 35% in women. Discussion The results from the 4S study, the ﬁrst study to demonstrate unequivocally the beneﬁts of statin therapy in CHD patients, were presented in 1994 (Anonymous 1994). In response to the results of the study and other, ensuing lipid-lowering secondary prevention trials treatment with statins in order to improve patient outcome is now standard practice in CHD patients. The present study provided an opportunity to investigate the implementation of this landmark study. Over the 9-year period between 1994 and 2002, the use of lipid-lowering medication (eg, statins) increased from a low to a markedly high level in younger patients with a ﬁrst AMI, with a concomitant decrease in lipid levels. Despite the huge increase in lipid-lowering drug treatment, in which there was an increase from about 10% in 1994 to 90% in 2002, current target levels of 4.5 mmol/l for serum cholesterol were not achieved in a signiﬁcant proportion of these patients. The results from the study correspond with those from the Swedish centre (Malmö) in the Euroaspire II study (Anonymous 2001) except for the higher percentage treated with a statin in our study (90% compared with 74% in CHD patients in Euroaspire II). In the Euroaspire II sur- vey 65% of the patients reached target levels ( 5 mmol/l) for serum total cholesterol; in our study 62% reached these same target levels. In 2002, the Heart Protection Study (HPS) (HPSCG 2002) established that lowering cholesterol with 40 mg simvastatin daily substantially reduced the incidence of major vascular events in high-risk individuals, irrespective 1994 1995 1996 1997 1998 1999 2000 2001 2002 Figure 2 Mean serum cholesterol in men and women at 3-months follow-up after hospitalization for ﬁrst myocardial infarction during 1994–2002. 1048 Vascular Health and Risk Management 2007:3(6) Women Men Women Men