Long-term mortality after 5-year multifactorial primary prevention of cardiovascular diseases in middle-aged men

Article Abstract:

Several large studies have attempted to determine the effectiveness of interventions to reduce the risk of cardiovascular disease (CVD). Although some studies have suggested that treatment lowered the risk of heart attack, others showed no benefit or even negative results. To learn more about the issue, a study was carried out of 1,222 middle-aged, healthy male business executives in Finland. The subjects, all of whom had CVD risk factors, were divided into two groups: in one, they received various types of intervention to lower the risk of CVD; in the other, they did not. Subjects in the first group were treated with dietetic-hygienic measures and drugs to lower cholesterol and reduce blood pressure if advice alone did not seem effective. Subjects in the second group were not treated. The trial lasted five years, from 1974 to 1980: this article reports on the health of the subjects in the years after the trial ended. The risk of coronary heart disease was reduced by 46 percent during the trial years, but in the years after the trial, coronary events, such as heart attacks, were more frequent in the intervention group. Ten years after the end of the trial, almost 11 percent of the treated men had died (67 deaths), compared with 7.5 percent (46 deaths) of the untreated men. Mortality due to coronary heart disease (CHD; disease of the vessels that deliver blood to the heart) was 5.6 percent in the intervention group and 2.3 percent in the control group, a relative risk of death from heart attack or sudden cardiac death almost two and a half times higher for those in the former group. There were 13 violent deaths in the intervention group and 1 in the untreated group, a curious result found in other studies as well. These surprising findings may be a consequence of the harmful effects of certain drugs or drug combinations. Greater CHD mortality was associated with beta-blocker drugs, widely used to control high blood pressure. Clofibrate, a drug to lower cholesterol, was associated with a slight increase in mortality, but no conclusions about its effects could be drawn because it was generally discontinued after the five-year trial ended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cardiovascular diseases, Development and progression, Adrenergic beta blockers, Adrenergic beta-antagonists

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Current therapy for hypercholesterolemia

Article Abstract:

An excessive amount of cholesterol in the blood (hypercholesterolemia) increases the risk of coronary heart disease (CHD). Several studies show that a reduction in cholesterol levels in the blood corresponds to fewer incidences of heart attack and death related to heart disease. Long periods of treatment with the vitamin niacin significantly reduce the number of heart attacks (by the fifth year of treatment) and death from heart disease (by the seventh year). Patients with high levels of low-density lipoproteins, which transport cholesterol in the blood, are particularly at risk for heart disease and should be treated for hypercholesterolemia. This review article discusses when, in whom, and how to treat hypercholesterolemia. Various treatment methods are evaluated, including diet and drug therapies. The results of experiment are clearly that lowering elevated levels of low-density lipoprotein (LDL) cholesterol reduces CHD risk, and more ambiguously that raising low levels of high-density lipoprotein (HDL) cholesterol is beneficial.

Analysis, Apolipoproteins, Diet therapy, column

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The Multiple Risk Factor Intervention Trial (MRFIT): a return to a landmark trial

Article Abstract:

The Multiple Risk Factor Intervention Trial (MRFIT) was the first large study to determine if modifying risk factors for coronary heart disease (CHD) could prevent the disease from developing in healthy men. The men received usual care or an aggressive intervention that included advice about reducing cholesterol levels, smoking cessation and hypertension treatment. At the time of the study, these were considered the biggest risk factors for CHD. The aggressive intervention did not significantly reduce mortality rates at the time, but long-term follow-up may reveal a benefit.

Hypertension

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