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Lipoproteins and coronary heart disease in the Helsinki Heart Study
M Mänttäri1, J K Huttunen, P Koskinen
1First Department of Medicine, University of Helsinki, Finland.
Insights
Gemfibrozil significantly improved lipid profiles in men, lowering total cholesterol, LDL-cholesterol, and triglycerides while increasing HDL-cholesterol, especially in compliant patients. These lipid changes correlated with reduced coronary event risk.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- The Helsinki Heart Study investigated gemfibrozil's efficacy in primary prevention of coronary heart disease.
- Serum lipid profiles are critical indicators of cardiovascular risk.
Purpose of the Study:
- To analyze the impact of gemfibrozil on serum lipid levels in men.
- To determine the relationship between baseline lipid levels, treatment compliance, and gemfibrozil's effects.
- To assess how lipid changes influence coronary event incidence.
Main Methods:
- Controlled primary prevention trial comparing gemfibrozil to placebo.
- Analysis of serum lipid changes (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides) based on baseline levels and treatment compliance.
- Ultracentrifuge analysis of lipoprotein subfractions (HDL2, HDL3).
Main Results:
- Gemfibrozil significantly reduced total cholesterol, LDL-cholesterol, and triglycerides, and increased HDL-cholesterol, particularly in highly compliant subjects.
- Treatment response varied with baseline lipid levels, with significant associations for LDL-cholesterol and triglycerides.
- Greatest coronary event reductions were observed in patients with low baseline HDL-cholesterol and high baseline triglycerides.
- Increased HDL-cholesterol and decreased LDL-cholesterol were linked to lower coronary event risk.
Conclusions:
- Gemfibrozil effectively modifies serum lipids, with effects modulated by baseline levels and compliance.
- The lipid-modifying effects of gemfibrozil are associated with a reduced risk of coronary events.
- Personalized treatment strategies considering baseline lipid profiles may optimize gemfibrozil's preventive effects.
Abstract:
The changes in serum lipids in men treated with gemfibrozil in the Helsinki Heart Study, a controlled primary prevention trial of coronary heart disease, varied according to baseline lipid levels, type of dyslipidaemia, and treatment compliance. In subjects with the best treatment compliance, gemfibrozil induced mean decreases of 14% in total cholesterol, 15% in low density lipoprotein (LDL)-cholesterol, and 45% in triglycerides, and a mean increase of 14% in high density lipoprotein (HDL)-cholesterol, compared with placebo. These changes were significantly greater than those observed in the entire cohort. There was a strong association between baseline levels and the response to treatment (expressed as the difference in mmol l-1 between the gemfibrozil- and placebo-treated groups) for LDL-cholesterol and triglycerides. In contrast, the corresponding change in HDL-cholesterol was not dependent on the baseline level. Ultracentrifuge analysis in a subsample of the cohort revealed that gemfibrozil raised the level of HDL3-cholesterol but had little effect on HDL2-cholesterol. The gemfibrozil-associated reduction in the incidence of definite coronary events varied according to lipid values at baseline and their changes during treatment. The greatest reductions were seen in subjects with low initial HDL-cholesterol and high initial triglycerides. In the gemfibrozil group, the increase in HDL-cholesterol and decrease in LDL-cholesterol were associated with significantly lower risk of coronary events.
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