Fifteen year mortality in Coronary Drug Project patients: Long-term benefit with niacin

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The Coronary Drug Project was conducted between 1966 and 1975 to assess the long-term efficacy and safety of five lipid-influencing drugs in 8,341 men aged 30 to 64 years with electrocardiogram-documented previous myocardial infarction. The two estrogen regimens and dextrothyroxine were discontinued early because of adverse effects. No evidence of efficacy was found for the Clofibrate treatment. Niacin treatment showed modest benefit in decreasing definite nonfatal recurrent myocardial infarction but did not decrease total mortality. With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004). This late benefit of niacin, occurring after discontinuation of the drug, may be a result of a translation into a mortality benefit over subsequent years of the early favorable effect of niacin in decreasing nonfatal reinfarction or a result of the cholesterol-lowering effect of niacin, or both.

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From the Maryland Medical Research Institute, Baltimore, Maryland

From the Mayo Clinic, Rochester, Minnesota

From the Emory University School of Medicine, Atlanta, Georgia

§

From the Northwestern University Medical School, Chicago, Illinois

From the National Heart, Lung, and Blood Institute, Bethesda, Maryland

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From the School of Public Health, University of Minnesota, Minneapolis, Minnesota. The Coronary Drug Project was carried out as a collaborative study supported by research grants and other funds from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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A list of the key bodies and senior staff members of the Coronary Drug Project Mortality Follow-Up Program is presented in Appendix B.