What question did this study set out to answer?

To determine the long-term mortality effects of a 5-year multifactorial primary cardiovascular disease prevention program in middle-aged men with cardiovascular risk factors.

September 4, 1991JAMA

Long-term Mortality After 5-Year Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men

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Why the study?

Does a 5-year multifactorial primary prevention program reduce long-term mortality in clinically healthy middle-aged men with CVD risk factors?

Population

1,222 clinically healthy middle-aged men (business executives born 1919-1934) with CVD risk factors

Comparison

5-year multifactorial primary prevention… vs Control group not treated by the investigators

Design

RCT, randomized

Follow-up

15 years (1974 to 1989)

Authors

TSTimo StrandbergPreventive Cardiology

Discussion

Member takes

Implication

Caution against multifactorial primary prevention in middle-aged men with CVD risk factors; challenges presumed long-term mortality benefits.

Key Points

To determine the long-term mortality effects of a 5-year multifactorial primary cardiovascular disease prevention program in middle-aged men with cardiovascular risk factors.
Randomized controlled trial conducted in Helsinki, Finland, assigning 1,222 clinically healthy men aged 40–55 with cardiovascular risk factors to an intervention group (n=612) or control group (n=610).
Intervention subjects received 5 years (1974–1980) of intensive dietetic counseling and frequent medical therapy with hypolipidemic (clofibrate, probucol) and antihypertensive (beta-blockers, diuretics) agents, with posttrial mortality tracked through December 31, 1989.
Total coronary heart disease risk dropped by 46% in the intervention arm at the end of the 5-year trial, but risk factor differences between arms leveled off over the subsequent 5 posttrial years.
Over the 15-year period (1974–1989), total mortality was significantly higher in the intervention group than in controls (67 vs 46 deaths; RR, 1.45; 95% CI, 1.01–2.08; P=.048).
Intervention participants experienced excess cardiac mortality (34 vs 14 deaths; RR, 2.42; 95% CI, 1.31–4.46; P=.001) and violent deaths (13 vs 1; RR, 13.0; 95% CI, 1.70–98.7; P=.002), which were not explained by multiple logistic regression modeling.

Structured PICO

Does a 5-year multifactorial primary prevention program reduce long-term mortality in clinically healthy middle-aged men with CVD risk factors?

Population

1,222 clinically healthy middle-aged men (business executives born 1919-1934) with CVD risk factors

Intervention

5-year multifactorial primary prevention including intensive dietetic-hygienic measures and frequently hypolipidemic (clofibrate and/or probucol) and antihypertensive (beta-blockers and/or diuretics) drugs, with visits every 4 months

Comparator

Control group not treated by the investigators

Outcome

Total mortality, cardiac mortality, and mortality due to other causes between 1974 and 1989 (up to 15 years follow-up)hard clinical

A 5-year multifactorial primary prevention program unexpectedly increased long-term total and cardiac mortality in middle-aged men with CVD risk factors.

Cite This Study

Timo Strandberg (1991) studied this question.

synapsesocial.com/papers/6a913ec2e771dc7bc333f5fb https://doi.org/10.1001/jama.1991.03470090059032

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Implication

Caution against multifactorial primary prevention in middle-aged men with CVD risk factors; challenges presumed long-term mortality benefits.

Long-term Mortality After 5-Year Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Long-term Mortality After 5-Year Multifactorial Primary Prevention of Cardiovascular Diseases in Middle-aged Men

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider