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The Helsinki Heart Study: coronary heart disease incidence during an extended follow-up
O P Heinonen1, J K Huttunen, V Manninen
1National Public Health Institute, University of Helsinki, Finland.
Insights
Gemfibrozil treatment demonstrated a long-term preventive effect on coronary heart disease (CHD) events. This study confirmed that gemfibrozil can postpone cardiac events, suggesting benefits beyond the initial treatment period.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Identifying effective preventive strategies is crucial for public health.
- Gemfibrozil is a lipid-regulating agent with potential cardioprotective properties.
Purpose of the Study:
- To confirm the preventive efficacy of gemfibrozil in coronary heart disease (CHD).
- To estimate the long-term impact of gemfibrozil treatment on CHD events.
- To evaluate the sustained effects of gemfibrozil beyond a primary prevention trial.
Main Methods:
- Extended follow-up of participants from the Helsinki Heart Study, a 5-year CHD primary prevention trial.
- Involved offering gemfibrozil treatment to all participants with biannual follow-up for an additional 3.5 years.
- Compared definite fatal and non-fatal CHD events between gemfibrozil and placebo groups.
Main Results:
- During the post-trial period, CHD events were reduced by approximately 40% in original treatment groups, with similar incidence rates to the placebo group 5 years prior.
- The lowest post-trial CHD incidence was observed in men from the placebo group who subsequently chose gemfibrozil.
- Cardiovascular mortality was similar, but all-cause mortality was slightly higher in the original gemfibrozil group compared to the placebo group.
Conclusions:
- Prolonged gemfibrozil treatment effectively postpones cardiac events.
- The protective effect of gemfibrozil is attributed to both atherosclerosis attenuation and mechanisms influencing acute cardiac events.
- Gemfibrozil offers sustained benefits in CHD prevention, impacting both chronic and acute cardiovascular outcomes.
Objectives:
To confirm that coronary heart disease (CHD) can be prevented by gemfibrozil treatment and to estimate the long-term effect of the treatment.
Design:
All participants of the Helsinki Heart Study, a controlled 5-year CHD primary prevention trial with gemfibrozil and placebo, were offered gemfibrozil treatment and biannual follow-up for 3.5 more years.
Setting:
By the end of the multi-clinic double-blind trial, a 34% difference in definite cardiac events (56 vs. 84; P < 0.2) had developed between the gemfibrozil and placebo groups.
Subjects:
There were 2046 dyslipidaemic men in the gemfibrozil group at randomization, 1961 started the extended follow-up; the comparison group comprised 2035 men, and 5 years later 1928 men.
Interventions:
Gemfibrozil was selected by 66.3% of gemfibrozil and 68.5% of placebo men without previous CHD end-points.
Main Outcome Measures:
Definite fatal and non-fatal CHD events are reported, possible CHD events were recorded but reported selectively.
Results:
During the post-trial period the numbers of definite CHD events in both groups (54 vs. 47; NS) were smaller than expected without treatment, namely a reduction of around 40% for the original treatment groups. The mean incidence rates were in fact similar to that in the placebo group 5 years earlier. The post-trial CHD incidence was lowest amongst the placebo group men who later selected gemfibrozil. Cardiovascular mortality over the entire study period was similar but all-cause mortality was slightly higher amongst men of the original gemfibrozil group compared to the placebo group men (P = 0.19).
Conclusions:
Thus prolonged gemfibrozil treatment postpones cardiac events. This protective effect presumably involves both attenuation of atherosclerosis and mechanisms related to acute cardiac events.