Related Experiment Videos
Mortality rates after multifactorial primary prevention of cardiovascular diseases
V A Naukkarinen1, T E Strandberg, H T Vanhanen
1Department of Medicine, Jorvi District Hospital, Espoo, Finland.
Insights
Cardiovascular disease prevention trials improved risk factors but showed no long-term mortality benefit. Initial risk factors like overweight and smoking predicted 11-year mortality, not trial interventions.
Area of Science:
- Cardiovascular disease epidemiology
- Clinical trial analysis
- Preventive medicine
Background:
- A 5-year multifactorial primary prevention trial for cardiovascular diseases (CVD) was conducted from 1974-1980.
- Participants received health education before and during the trial.
- The trial aimed to reduce CVD risk factors in middle-aged men.
Purpose of the Study:
- To assess the eleven-year mortality rates following a 5-year cardiovascular disease prevention trial.
- To identify initial risk factors associated with long-term cardiovascular mortality.
- To evaluate the sustained impact of the intervention on mortality outcomes.
Main Methods:
- Study population: Middle-aged men from a randomized 5-year primary prevention trial (intervention group, n=612; randomized control group, n=610) and a non-randomized low-risk group (n=593).
- Data collection: Eleven-year mortality rates (cardiovascular disease deaths) were tracked post-trial.
- Statistical analysis: Multiple logistic regression was used to identify predictors of mortality.
Main Results:
- The intervention group showed improved risk factor status but a trend towards higher 5-year coronary events compared to the randomized control group.
- Eleven-year cardiovascular mortality rates were 2.45% (intervention), 1.97% (randomized control), and 0.51% (non-randomized low risk).
- Overweight, hypercholesterolemia, and smoking were identified as initial risk factors for 11-year cardiovascular mortality.
Conclusions:
- The multifactorial primary prevention trial did not demonstrate a significant long-term reduction in cardiovascular mortality.
- Initial risk factors, rather than trial interventions, were strongly associated with long-term mortality.
- Beta-blocker use during the trial was not linked to increased cardiac deaths during the 11-year follow-up.
Abstract:
Eleven-year mortality rates were studied in middle aged men who had participated in a randomised 5-year multifactorial primary prevention trial on cardiovascular diseases during 1974-1980. The men were given health education advice before the study. The 5-year trial markedly improved the risk factor status in the men in the intervention group (n = 612), but their 5-year incidence of total coronary events tended to be higher than in the randomised non-treated control group (n = 610) and significantly higher than in an non-randomised, non-treated low risk group (n = 593). During the six years following the discontinuation of the trial, 11 deaths from cardiovascular disease occurred both in the intervention and in the control groups and three in the non-randomised low risk group. Thus, the cumulative eleven-year cardiovascular mortality rates and their 95% confidence intervals (Cl95) were 2.45% (Cl95: 1.38, 3.67) in the intervention group and 1.97% (Cl95: 1.01, 3.34) in the randomised high risk control group. In the non-randomised low risk group the mortality rate was 0.51 (Cl95: 0.01, 1.46). Multiple logistic regression analysis showed that overweight and hypercholesterolaemia, and smoking in the high risk controls, were the initial risk factors associated with the 11-year cardiovascular mortality. The latter was not accumulated in any treatment measure during the prevention period. Furthermore, despite the unfavourable effect of beta-blocking agents on total cardiac events during the intervention, beta-blockers were not associated with cardiac deaths in the 11-year follow up.(ABSTRACT TRUNCATED AT 250 WORDS)