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Helsinki Heart Study. New perspectives in the prevention of coronary heart disease
J K Huttunen1, M H Frick, O P Heinonen
1First Department of Medicine, University of Helsinki, Finland.
Insights
The Helsinki Heart Study found that gemfibrozil significantly reduced coronary heart disease incidence by lowering low density lipoprotein (LDL) cholesterol and triglycerides while increasing high density lipoprotein (HDL) cholesterol.
Area of Science:
- Cardiology
- Preventive Medicine
- Lipid Metabolism
Background:
- Coronary heart disease (CHD) is a major health concern in middle-aged men.
- Elevated non-high density lipoprotein (HDL) cholesterol is a risk factor for CHD.
- Targeting lipid profiles may offer a strategy for primary prevention of CHD.
Purpose of the Study:
- To evaluate the effect of gemfibrozil on plasma lipid levels.
- To assess the impact of lipid modification on the primary prevention of coronary heart disease.
- To investigate the relationship between changes in low density lipoprotein (LDL) and HDL cholesterol and CHD risk.
Main Methods:
- A randomized, placebo-controlled trial involving middle-aged men with elevated non-HDL cholesterol.
- Participants received either gemfibrozil (600mg twice daily) or a placebo for 5 years.
- Lipid profiles (LDL, HDL, triglycerides) and CHD event incidence were monitored.
Main Results:
- Gemfibrozil treatment resulted in an 11% decrease in LDL cholesterol, a 35% decrease in triglycerides, and an 11% increase in HDL cholesterol compared to placebo.
- A 34% reduction in coronary heart disease incidence was observed in the gemfibrozil group.
- The CHD risk reduction was most pronounced in subjects with type IIB hyperlipoproteinemia.
Conclusions:
- Gemfibrozil effectively modifies lipid profiles, leading to a significant reduction in coronary heart disease incidence in middle-aged men.
- Changes in HDL and LDL cholesterol levels were associated with reduced CHD risk in the treatment group.
- Lipid modification strategies, such as gemfibrozil therapy, are beneficial for primary prevention of coronary heart disease.
Abstract:
The Helsinki Heart Study tested the effect of modifying plasma low density lipoprotein (LDL)- and high density lipoprotein (HDL)-cholesterol on the primary prevention of coronary heart disease in middle-aged men with non-HDL-cholesterol greater than or equal to 5.2 mmol/L (200 mg/dl). One group (2046 men) received 600mg of gemfibrozil twice daily, and the other (2035 men) received placebo. Averaged over the 5-year trial period, gemfibrozil induced mean decreases of 11% in LDL-cholesterol and 35% in triglycerides and a mean increase of 11% in HDL-cholesterol compared with placebo. These changes were accompanied by a 34% reduction (number of end-points; 56 vs 84) in the incidence of coronary heart disease. The reduction was largest in subjects with type IIB hyperlipoproteinaemia and smallest in subjects with type IIA hyperlipoproteinaemia. The changes in serum HDL- and LDL-cholesterol during the trial were associated (p less than 0.02 and p less than 0.05, respectively) with the risk of coronary heart disease in the gemfibrozil group, but not in the placebo group.