To the Editor.
—Regarding the long-term results of the Finnish trial by Strandberg et al,1 the unexpected finding of an excess cardiac risk developing after completion of the trial is most intriguing. The authors discussed a series of possible reasons but had no data on risk factor developments after 1985, where we see the most dramatic divergence of end points between treatment groups. It is hoped that a survey for risk factors in surviving subjects will appear soon.In this extension of the trial, it is noteworthy that the recording of diagnoses-events was done by the routine system at the Central Bureau of Statistics, thereby securing blinded codes of causes of death. However, the knowledge of a person having participated in a drug trial may give biased diagnoses if not verified by autopsy reports. It is likely that this bias could be different in the intervention as compared with
Holme I. Long-term Mortality After Primary Prevention for Cardiovascular Disease. JAMA. 1992;267(16):2183. doi:10.1001/jama.1992.03480160041017