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HDL-cholesterol as a risk factor in coronary heart disease. An update of the Helsinki Heart Study.

https://arctichealth.org/en/permalink/ahliterature103517
Source
Drugs. 1990;40 Suppl 1:7-12
Publication Type
Article
Date
1990
Author
M H Frick
V. Manninen
J K Huttunen
O P Heinonen
L. Tenkanen
M. Mänttäri
Author Affiliation
First Department of Medicine, University Central Hospital, Helsinki, Finland.
Source
Drugs. 1990;40 Suppl 1:7-12
Date
1990
Language
English
Publication Type
Article
Keywords
Cholesterol - blood
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Coronary Disease - blood - epidemiology
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Lipids - blood
Male
Risk factors
Abstract
The aim of the Helsinki Heart Study, a 5-year primary prevention placebo-controlled study involving 4081 dyslipidaemic men (aged 40 to 55 years), was to investigate if increasing high density lipoprotein (HDL)-cholesterol plasma levels and decreasing low density lipoprotein (LDL)-cholesterol levels would reduce the incidence of coronary heart disease. Gemfibrozil 600mg twice daily was administered to induce these changes in lipoprotein levels. Baseline HDL-cholesterol levels in the study group were similar to those in the general population. Data from patients treated with placebo were analysed to investigate the influence of HDL-cholesterol levels on the incidence of coronary heart disease. Using the number of cardiac end-points per 1000 person-years to indicate the risk of coronary heart disease, it was clear that elevated HDL-cholesterol levels reduced the risk of coronary heart disease while the incidence increased at low HDL-cholesterol levels. This relationship was not altered when the effect of HDL-cholesterol levels was analysed jointly with other coronary risk factors (age, smoking or blood pressure). A weaker association was seen between LDL-cholesterol and risk of coronary heart disease, and triglycerides appeared to have no significant effect on the incidence of the disease. The data clearly suggest that HDL-cholesterol is a strong predictor of the incidence of coronary heart disease in the placebo group of the Helsinki Heart Study.
PubMed ID
2289410 View in PubMed
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The Helsinki Heart Study: an 8.5-year safety and mortality follow-up.

https://arctichealth.org/en/permalink/ahliterature219116
Source
J Intern Med. 1994 Jan;235(1):31-9
Publication Type
Article
Date
Jan-1994
Author
J K Huttunen
O P Heinonen
V. Manninen
P. Koskinen
T. Hakulinen
L. Teppo
M. Mänttäri
M H Frick
Author Affiliation
National Public Health Institute, University of Helsinki, Finland.
Source
J Intern Med. 1994 Jan;235(1):31-9
Date
Jan-1994
Language
English
Publication Type
Article
Keywords
Adult
Cause of Death
Coronary Disease - mortality - prevention & control
Finland - epidemiology
Follow-Up Studies
Gemfibrozil - adverse effects - therapeutic use
Humans
Incidence
Male
Middle Aged
Mortality
Neoplasms - chemically induced - mortality
Abstract
Earlier monitoring of all symptoms, hospital admissions, cancer diagnoses and causes of death during gemfibrozil treatment had raised some suspicions which called for further follow-up.
Close monitoring of selected, potentially adverse events amongst treated subjects after a placebo-controlled trial and comparing occurrences to those in various untreated groups.
All participants of the Helsinki Heart Study (a controlled, 5-year, multi-clinic coronary heart disease (CHD) primary prevention trial with gemfibrozil and placebo) were offered gemfibrozil treatment and twice yearly follow-up for 3.5 years. Untreated groups in the source population and national cancer statistics were utilized in comparisons.
Of the 2046 dyslipidaemic men initially randomized to gemfibrozil, 2002 survivors entered the 3.5-year follow-up; of the 2035 initial placebo men, 1992 continued to be monitored.
Gemfibrozil was chosen for the follow-up by 66.3% of the gemfibrozil-treated and 68.5% of the placebo-treated men.
Gastrointestinal symptoms, surgery, strokes, cancer incidence, mortality by cause.
Gastrointestinal symptoms remained more common in the original gemfibrozil group. After 8.5 years strokes numbered 32 (gemfibrozil) vs. 37 (placebo), violent deaths 16 vs. 14, and cancers 51 in both groups. Total mortality was equal during the original 5 years, but higher in the gemfibrozil group post-trial, leading to an 8.5 year mortality of 101 vs. placebo 83 (P = 0.19). This was mainly a result of higher cancer mortality in the gemfibrozil (30) than the placebo group (18, P = 0.08). An additional 18-month post-study registry follow-up disclosed 13 placebo and five gemfibrozil cancer deaths, altering the cancer mortality to gemfibrozil 35 vs. placebo 31 at 10 years.
The most plausible explanation for the discrepancy between cancer incidence and cancer-specific mortality, based mainly on comparison with untreated groups, is delayed diagnosis. The increased cancer and total mortality is most probably due to chance, based on the later reversal of trends.
Notes
Comment In: J Intern Med. 1994 Jan;235(1):1-48283155
PubMed ID
8283157 View in PubMed
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The Helsinki Heart Study: basic design and randomization procedure.

https://arctichealth.org/en/permalink/ahliterature234650
Source
Eur Heart J. 1987 Oct;8 Suppl I:1-29
Publication Type
Article
Date
Oct-1987
Author
M. Mänttäri
O. Elo
M H Frick
K. Haapa
O P Heinonen
P. Heinsalmi
P. Helo
J K Huttunen
P. Kaitaniemi
P. Koskinen
Author Affiliation
Helsinki Heart Study, Finland.
Source
Eur Heart J. 1987 Oct;8 Suppl I:1-29
Date
Oct-1987
Language
English
Publication Type
Article
Keywords
Cholesterol, Dietary - administration & dosage
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Clinical Trials as Topic
Coronary Disease - prevention & control
Double-Blind Method
Finland
Gemfibrozil
Humans
Hypolipidemic Agents - therapeutic use
Male
Middle Aged
Pentanoic Acids - therapeutic use
Random Allocation
Valerates - therapeutic use
Abstract
The Helsinki Heart Study is a coronary primary prevention trial in a group of middle aged men with lipid abnormalities. Its aim is to investigate the effects on the incidence of coronary heart disease of simultaneously lowering serum total and low density lipoprotein (LDL)-cholesterol and elevating high density lipoprotein (HDL)-cholesterol with gemfibrozil, over a period of 5 years. Participants were selected from a population of 23 531 men between 40 and 55 years of age. The mean serum total cholesterol among 18 966 screened subjects was 6.3 mmol l-1 (245 mg dl-1) and the mean HDL-cholesterol 1.3 mmol l-1 (50.3 mg dl-1). All subjects meeting the lipid acceptance criterion of non-HDL-cholesterol (i.e. total cholesterol minus HDL-cholesterol) greater than 5.2 mmol l-1 (200 mg dl-1) on two separate occasions two to three months apart, who were free from coronary heart disease or other major illness, were invited to participate. The total cholesterol level for the final 4081 study participants was 7.5 mmol l-1 (290 mg dl-1) and HDL-cholesterol was 1.23 mmol l-1 (47.6 mg dl-1). Mean systolic and diastolic blood pressures were 141.7 and 91.3 mmHg. About 15% of participants were hypertensive and 36% were smokers. A total of 2051 men were randomly allocated to receive gemfibrozil 600 mg twice daily and 2030 matching placebo capsules. A cholesterol-lowering diet was also prescribed for all participants. The randomized treatment groups were well balanced. Equal distribution of major risk factors was achieved in relevant sub-groups. This report describes the procedures involved in setting up the study, summarizes the baseline data obtained and reviews the success of the randomization procedure. Finally, it compares the design of this study with that of some other major preventive trials.
PubMed ID
3322826 View in PubMed
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The Helsinki Heart Study: coronary heart disease incidence during an extended follow-up.

https://arctichealth.org/en/permalink/ahliterature219115
Source
J Intern Med. 1994 Jan;235(1):41-9
Publication Type
Article
Date
Jan-1994
Author
O P Heinonen
J K Huttunen
V. Manninen
M. Mänttäri
P. Koskinen
L. Tenkanen
M H Frick
Author Affiliation
National Public Health Institute, University of Helsinki, Finland.
Source
J Intern Med. 1994 Jan;235(1):41-9
Date
Jan-1994
Language
English
Publication Type
Article
Keywords
Adult
Coronary Disease - mortality - prevention & control
Finland - epidemiology
Follow-Up Studies
Gemfibrozil - therapeutic use
Humans
Incidence
Male
Middle Aged
Treatment Outcome
Abstract
To confirm that coronary heart disease (CHD) can be prevented by gemfibrozil treatment and to estimate the long-term effect of the treatment.
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.
By the end of the multi-clinic double-blind trial, a 34% difference in definite cardiac events (56 vs. 84; P
Notes
Comment In: J Intern Med. 1994 Jan;235(1):1-48283155
PubMed ID
8283158 View in PubMed
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Helsinki Heart Study. New perspectives in the prevention of coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature234123
Source
Drugs. 1988;36 Suppl 3:32-6
Publication Type
Article
Date
1988
Author
J K Huttunen
M H Frick
O P Heinonen
P. Heinsalmi
V. Manninen
M. Mänttäri
M. Romo
Author Affiliation
First Department of Medicine, University of Helsinki, Finland.
Source
Drugs. 1988;36 Suppl 3:32-6
Date
1988
Language
English
Publication Type
Article
Keywords
Adult
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Clinical Trials as Topic
Coronary Disease - prevention & control
Double-Blind Method
Finland
Gemfibrozil - therapeutic use
Humans
Hyperlipoproteinemias - epidemiology - physiopathology - prevention & control
Lipids - blood
Male
Middle Aged
Myocardial Infarction - epidemiology - physiopathology - prevention & control
Random Allocation
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.
PubMed ID
3076118 View in PubMed
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How to define coronary heart disease in register-based follow-up studies: experience from the Helsinki Heart Study.

https://arctichealth.org/en/permalink/ahliterature208274
Source
Ann Med. 1997 Jun;29(3):253-9
Publication Type
Article
Date
Jun-1997
Author
K. Pietilä
L. Tenkanen
M. Mänttäri
V. Manninen
Author Affiliation
School of Public Health, University of Tampere, Finland.
Source
Ann Med. 1997 Jun;29(3):253-9
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Coronary Disease - classification - epidemiology - mortality
Finland - epidemiology
Follow-Up Studies
Humans
Male
Middle Aged
Myocardial Infarction - epidemiology
Registries
Sensitivity and specificity
Abstract
Information on coronary heart disease (CHD) obtained from the Finnish Hospital Discharge and Cause-of-Death Registers was compared with that collected in the Helsinki Heart Study (HHS) during an 8.5-year follow-up. The purpose of the comparison was two-fold, firstly, to study the accuracy of registration of CHD and secondly, to find out what diagnostic codes to use for CHD in register-based follow-up studies. The HHS cases were used as the 'golden standard' and the CHD deaths and definite nonfatal acute myocardial infarctions (AMIs) (all diagnoses) were taken from the registers to establish the sensitivity of the Hospital Discharge and Cause-of-Death Registers combined. The sensitivity was 0.84 during the period 1980-86 and 0.87 during 1987-90, with the positive predictive values 0.94 and 0.92 respectively. The treatment effects seen in the HHS were compared with the effects that would have emerged, if register-based information only had been used with different definitions of CHD. Of the register-based calculations, the one with the definition 'all CHD deaths and hospitalizations with the ICD-8 code 410' came closest to the HHS result, with a 32% reduction (P=0.028 one-sided) of CHD incidence, while the original HHS result was a 34% reduction (P=0.008 one sided). However, when comparing Kaplan-Meier plots of cumulative hazards of CHD, the plot with a wider definition of CHD (ICD-8 and ICD-9 codes 410-414) came closest to the HHS experience, especially if revascularizations were included in the latter. Definite AMI as a single definition of CHD might thus not be sufficient when studying CHD risk, instead, at least two parallel definitions of CHD should be used.
PubMed ID
9240631 View in PubMed
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Joint effects of an aldosterone synthase (CYP11B2) gene polymorphism and classic risk factors on risk of myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature200152
Source
Circulation. 1999 Nov 30;100(22):2213-8
Publication Type
Article
Date
Nov-30-1999
Author
A. Hautanen
P. Toivanen
M. Mänttäri
L. Tenkanen
M. Kupari
V. Manninen
K M Kayes
S. Rosenfeld
P C White
Author Affiliation
Department of Medicine, University of Helsinki, Helsinki, Finland.
Source
Circulation. 1999 Nov 30;100(22):2213-8
Date
Nov-30-1999
Language
English
Publication Type
Article
Keywords
Adult
Aldosterone - blood - physiology
Aldosterone Synthase - genetics
Alleles
Baroreflex - genetics
Case-Control Studies
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Cohort Studies
Comorbidity
Double-Blind Method
Finland - epidemiology
Gemfibrozil - therapeutic use
Genetic Predisposition to Disease
Genotype
Humans
Hyperlipidemias - epidemiology
Hypolipidemic Agents - therapeutic use
Male
Middle Aged
Myocardial Infarction - epidemiology - etiology - genetics
Polymorphism, Genetic
Promoter Regions, Genetic - genetics
Risk factors
Smoking - adverse effects - epidemiology
Abstract
The -344C allele of a 2-allele (C or T) polymorphism in the promoter of the gene encoding aldosterone synthase (CYP11B2) is associated with increased left ventricular size and mass and with decreased baroreflex sensitivity, known risk factors for morbidity and mortality associated with myocardial infarction (MI). We hypothesized that this polymorphism was a risk factor for MI.
We used a nested case-control design to investigate the relationships between this polymorphism and the risk of nonfatal MI in 141 cases and 270 matched controls from the Helsinki Heart Study, a coronary primary prevention trial in dyslipidemic, middle-aged men. There was a nonsignificant trend of increasing risk of MI with number of copies of the -344C allele. However, this allele was associated in a gene dosage-dependent manner with markedly increased MI risk conferred by classic risk factors. Whereas smoking conferred a relative risk of MI of 2.50 (P=0.0001) compared with nonsmokers in the entire study population, the relative risk increased to 4.67 in -344CC homozygous smokers (relative to nonsmokers with the same genotype, P=0.003) and decreased to 1.09 in -344TT homozygotes relative to nonsmokers with this genotype. Similar joint effects were noted with genotype and decreased HDL cholesterol level as combined risk factors.
Smoking and dyslipidemia are more potent risk factors for nonfatal MI in males who have the -344C allele of CYP11B2.
Notes
Comment In: Circulation. 2000 Dec 12;102(24):E18311113060
PubMed ID
10577993 View in PubMed
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Leukocytes as a coronary risk factor in a dyslipidemic male population.

https://arctichealth.org/en/permalink/ahliterature224069
Source
Am Heart J. 1992 Apr;123(4 Pt 1):873-7
Publication Type
Article
Date
Apr-1992
Author
M. Mänttäri
V. Manninen
P. Koskinen
J K Huttunen
E. Oksanen
L. Tenkanen
O P Heinonen
M H Frick
Author Affiliation
First Department of Medicine, Helsinki University, Finland.
Source
Am Heart J. 1992 Apr;123(4 Pt 1):873-7
Date
Apr-1992
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Coronary Disease - blood - epidemiology
Finland - epidemiology
Humans
Hyperlipidemias - blood - epidemiology
Incidence
Leukocyte Count
Leukocytes - physiology
Male
Middle Aged
Prognosis
Regression Analysis
Risk factors
Sex Factors
Smoking - blood - epidemiology
Abstract
The role of an elevated serum leukocyte count (WBC) as a coronary risk factor was investigated using a nested case-control design in dyslipidemic middle-aged men (n = 420) participating in the Helsinki Heart Study, a coronary primary prevention trial. Baseline WBC was significantly higher, 6.93 (2.11) x 10(9)/L in subjects with cardiac events, than in controls, 6.26 (1.88) x 10(9)/L; p less than 0.002. This association was time-dependent, however, since the difference was not significant for events occurring during the second half of the 5-year study. Using nonsmokers in the lowest WBC tertile as the reference sample, the relative risks in the highest WBC tertile were 1.86 (95% confidence intervals [CI] 0.81 to 4.28) for nonsmokers and 3.07 (95% CI 2.23 to 8.19) for smokers. Logistic regression analysis including smoking in the model disclosed an independent contribution of elevated WBC to coronary heart disease. We conclude that elevated leukocyte count was a coronary risk factor even in this dyslipidemic population.
PubMed ID
1549995 View in PubMed
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Lipoprotein (a) and coronary heart disease risk: a nested case-control study of the Helsinki Heart Study participants.

https://arctichealth.org/en/permalink/ahliterature226123
Source
Atherosclerosis. 1991 Jul;89(1):59-67
Publication Type
Article
Date
Jul-1991
Author
M. Jauhiainen
P. Koskinen
C. Ehnholm
M H Frick
M. Mänttäri
V. Manninen
J K Huttunen
Author Affiliation
National Public Health Institute, Helsinki, Finland.
Source
Atherosclerosis. 1991 Jul;89(1):59-67
Date
Jul-1991
Language
English
Publication Type
Article
Keywords
Adult
Case-Control Studies
Coronary Artery Disease - blood - epidemiology - prevention & control
Finland - epidemiology
Gemfibrozil - therapeutic use
Humans
Lipids - blood
Lipoprotein(a)
Lipoproteins - blood
Longitudinal Studies
Male
Middle Aged
Prospective Studies
Risk factors
Abstract
To prospectively assess the role of lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease, the serum Lp(a) concentration was determined in 130 subjects without coronary events and in 138 patients in whom coronary events (i.e. fatal and non-fatal myocardial infarction and cardiac death) occurred during the 5-year Helsinki Heart Study. The participants of this study (n = 4081) were 40-55-year-old men who were devoid of coronary heart disease at the beginning of the trial; half were randomized to gemfibrozil and the other half to placebo treatment. In patients with coronary events blood pressure and total cholesterol were not significant predictors of the events but their LDL cholesterol was higher than compared to the control group in this cohort (P less than 0.05). The serum Lp(a) concentration was determined by immunoassay from samples obtained 3 months after the beginning of the trial and then stored at -20 degrees C until analysed. Studies on the effect of long term storage at -20 degrees C on serum Lp(a) levels did not reveal significant changes in Lp(a) concentration in sera stored for up to 8.5 years. The distribution of Lp(a) concentrations were similar in the men with coronary events and the controls. Nor did the mean or median levels of Lp(a) differ significantly between the two groups. Measurements of Lp(a) levels in fresh samples using 2 different immunoassays did not reveal any significant difference between the participants who had survived a myocardial infarction or participants without cardiac events. Thus, we conclude that in the Helsinki Heart Study cohort the serum Lp(a) level was not a predictor of future coronary events.
Notes
Comment In: Atherosclerosis. 1992 Apr;93(3):2611534228
PubMed ID
1837713 View in PubMed
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Predictive value for coronary heart disease of baseline high-density and low-density lipoprotein cholesterol among Fredrickson type IIa subjects in the Helsinki Heart Study.

https://arctichealth.org/en/permalink/ahliterature228403
Source
Am J Cardiol. 1990 Sep 4;66(6):24A-27A
Publication Type
Article
Date
Sep-4-1990
Author
V. Manninen
P. Koskinen
M. Manttari
J K Huttunen
D. Canter
H M Frick
Author Affiliation
First Department of Medicine, University of Helsinki, Finland.
Source
Am J Cardiol. 1990 Sep 4;66(6):24A-27A
Date
Sep-4-1990
Language
English
Publication Type
Article
Keywords
Cholesterol, HDL - blood
Cholesterol, LDL - blood
Coronary Disease - epidemiology
Finland - epidemiology
Gemfibrozil - therapeutic use
Humans
Hyperlipoproteinemia Type II - blood - complications - drug therapy
Incidence
Middle Aged
Placebos
Probability
Random Allocation
Risk factors
Triglycerides - blood
Abstract
In the Helsinki Heart Study 2,590 subjects (63.5% of total) had a type IIa hyperlipoproteinemia at screening. Baseline low-density lipoprotein (LDL) cholesterol (mean 193 mg/dl; 5 mmol/liter) and high-density lipoprotein (HDL) cholesterol (mean 50.2 mg/dl; 1.3 mmol/liter) showed no statistical correlation (r = 0.046). Both the placebo (1,293 patients) and gemfibrozil groups (1,297 patients) were divided into tertiles by baseline HDL and LDL cholesterol to determine the relative predictive risk of developing coronary artery disease. In a population with elevated LDL cholesterol, it is significant that the lipoprotein fraction with the greatest predictive value was HDL cholesterol. The severity of LDL cholesterol elevation did not provide any differential predictive value for coronary artery disease.
PubMed ID
2392990 View in PubMed
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12 records – page 1 of 2.