To the Editor. —
The Helsinki Heart Study1 demonstrated a significant decrease in coronary heart disease morbidity and mortality in middle-aged dyslipidemic men treated with gemfibrozil vs a placebo. Unfortunately, overall mortality was unchanged because of an increase in violence, accidents, and intracranial hemorrhage in the treated group. Further analysis2 of that study published in the Aug 5 issue of JAMA revealed that the reduction in coronary heart disease incidence over the placebo group was largest in the Fredrickson type IIB and smallest in the type IIA dyslipidemic men, despite the fact that the largest reductions in low-density lipoprotein cholesterol levels were in the type IIA group. Also, changes in lipoprotein levels in the gemfibrozil group were related to medication compliance—subjects were arbitrarily divided into quartiles based on average capsule counts.Data comparing overall mortality in each of the gemfibrozil-treated IIA, IIB, and IV Fredrickson types would be
Goldstein MR. Lipid Level Alterations in the Helsinki Heart Study. JAMA. 1989;261(4):554–555. doi:10.1001/jama.1989.03420040088012
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