title: The Helsinki Heart Study: coronary heart disease incidence during an extended follow-up.
abstract: OBJECTIVE
  To confirm that coronary heart disease (CHD) can be prevented by gemfibrozil treatment and to estimate the long-term effect of the treatment.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Gemfibrozil was selected by 66.3% of gemfibrozil and 68.5% of placebo men without previous CHD end-points.
  
  
  METHODS
  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.
authors.affiliation: National Public Health Institute, University of Helsinki, Finland.
authors.forename: O P
authors.initials: OP
authors.lastname: Heinonen
authors.forename: J K
authors.initials: JK
authors.lastname: Huttunen
authors.forename: V
authors.initials: V
authors.lastname: Manninen
authors.forename: M
authors.initials: M
authors.lastname: Mänttäri
authors.forename: P
authors.initials: P
authors.lastname: Koskinen
authors.forename: L
authors.initials: L
authors.lastname: Tenkanen
authors.forename: M H
authors.initials: MH
authors.lastname: Frick
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000401:mortality / Q000517:prevention & control*; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D015248:Gemfibrozil / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D015248:Gemfibrozil