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An 18-Year Mortality Follow-up of the Helsinki Heart Study

Leena Tenkanen, PhD; Matti Mänttäri, MD; Petri T. Kovanen, MD; Hanna Virkkunen, MSc; Vesa Manninen, MD

Arch Intern Med. 2006;166:743-748.

Background  The Helsinki Heart Study was a double-blind, placebo-controlled primary prevention trial among 4081 dyslipidemic middle-aged men to test the efficacy of gemfibrozil in the prevention of coronary heart disease (CHD). After the 5-year trial, the participants were notified of their treatment group and invited to continue or start gemfibrozil therapy free of charge through 1995. Approximately two thirds of participants in both groups chose gemfibrozil therapy. In this 18-year follow-up through 2000, we compared the CHD, cancer, and all-cause mortality among subjects in the original gemfibrozil (OG) group (n = 2046) with those in the original placebo (OP) group (n = 2035).

Methods  To provide an overview of the absolute risks in the 2 treatment groups as well as risk differences between them, we calculated crude mortality rates and presented Kaplan-Meier plots of survival with log-rank tests. We also estimated the relative risks (RRs) using Cox proportional hazards models with and without covariates.

Results  During the follow-up until 1995, subjects in the OG group had a 32% lower RR of CHD mortality (P = .03) compared with those in the OP group, and when followed up until 2000, the RR was 23% lower (P = .05). Overall, there were no differences in all-cause or cancer mortality. However, those in the OG group with both body mass index and triglyceride level in the highest tertiles had a 71% lower RR of CHD mortality (P<.001), a 33% lower RR of all-cause mortality (P = .03), and a 36% lower RR of cancer mortality (P = .22) compared with those in the OP group.

Conclusion  Long-term mortality follow-up showed that patients with dyslipidemia benefited from beginning treatment with gemfibrozil early, especially if their dyslipidemia entailed factors related to the metabolic syndrome.

Author Affiliations: Helsinki Heart Study, Helsinki, Finland (Drs Tenkanen, Mänttäri, and Manninen and Ms Virkkunen); School of Public Health, Tampere University, Tampere, Finland (Dr Tenkanen and Ms Virkkunen); Helsinki University Jorvi Hospital, Espoo, Finland (Dr Mänttäri); Helsinki University Central Hospital, Helsinki (Dr Manninen); and Wihuri Research Institute, Helsinki (Drs Mänttäri and Kovanen).
Group Information: Drs Tenkanen, Mänttäri, and Manninen and Ms Virkkunen are members of the Helsinki Heart Study Group.

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