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Odkazy a zdroje - Studie - Stockholm Study



Stockholm Study

Stockholm Ischaemic Heart Disease Secondary Prevention Study

Author(s)
Carlson LA, Rosenhamer G.

Title(s)
Reduction of mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by combined treatment with clofibrate and nicotinic acid.

Reference(s)
Carlson LA, Rosenhamer G. Acta Med Scand. 1988;223(5):405-18

Disease
Coronary artery disease, hypercholesterolemia

Purpose
The Stockholm Ischaemic Heart Disease Secondary Prevention Study was a randomized, open labeled study assessing the effects of lipid lowering with clofibrate and nicotinic acid combination on total mortality in survivors of myocardial infarction with dyslipidemia.

Study design
Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n = 276) and a Treatment group (n = 279). The latter was openly prescribed the combination of clofibrate and nicotinic acid for serum lipid lowering. Each patient should remain in the study for 5 years and be seen regularly every 4 months at a special IHD outpatient clinic within the hospital.

Follow-up
5 years

Patients
Consecutive survivors of a myocardial infarction from the Southern Hospital, below 70 years of age, were randomized into a Control group (n = 276) and a Treatment group (n = 279)

Treatment regimen
The participants allocated into the treatment group received clofibrate and nicotinic acid; the control-group subjects did not receive any treatment.

Concomitant therapy
-

Results
The concentration of serum cholesterol and triglyceride was lowered by 13% and 19%, respectively, in the Treatment group compared to the Control group. Total mortality was 82 cases in the Control group and 61 in the Treatment group, a 26% reduction (p less than 0.05). For patients above 60 years of age in the Treatment group the reduction in mortality was 28% (p less than 0.05). IHD mortality was reduced by 36% (p less than 0.01) in the Treatment group compared to the Control group. The beneficial effect of the serum lipid lowering treatment was related to the serum triglyceride concentration in two ways. First, it only occurred in patients with a triglyceride level greater than 1.5 mmol/l (n = 216). Secondly, it was most pronounced in the 44% of the treated patients who had a lowering of the serum triglyceride by 30% or more, and in this subgroup the reduction of IHD mortality was 60% (p less than 0.01). For serum cholesterol there were no such relations. The difference between serum triglycerides and cholesterol concerning these relations to the treatment outcome may be due to the fact that hypertriglyceridaemia was the most common hyperlipidaemia among our patients, occurring in 50%, while hypercholesterolaemia only occurred in 13%.