Oslo Study Research Articles

The effect of 8 years of strict glycaemic control on peripheral nerve function in IDDM patients: the Oslo Study

We have investigated the effect of long-term strict glycaemic control on peripheral and autonomic nerve function in 45 IDDM patients (age 18–42 years, diabetes duration 7–23 years) without clinical signs of neuropathy or other neurological disease. They were randomly assigned to treatment either with continuous insulin infusion, multiple injections (4–6 times daily), or conventional treatment (twice daily) for 4 years and followed prospectively for 8 years. Motor and sensory nerve conduction velocities were measured at the start and after 8 years. Autonomic nerve function tests were performed only once, after 8 years. A significant reduction of nerve conduction velocity was observed during 8 years in patients with mean HbA1 more than 10% (n=12, group mean 10.9%, range 10.1–13.2%) compared to patients with HbA1 less than 10% (n=33, group mean 9.0%, range 7.5–9.9%). Change of motor nerve conduction velocity in the peroneal nerve was: −4.8±4.9 (SD) vs −2.2±5.3 m/s (p<0.01). Change of motor nerve conduction velocity in the posterior tibial nerve was: −6.8±5.7 vs −3.9±5.1 m/s (p<0.05). No significant changes were observed in the ulnar nerve. Change of sensoric nerve conduction velocity in the sural nerve was: −8.9±8.0 vs −4.6±5.3 m/s (p<0.05). Multiple regression analysis showed that a change in HbA1 of 1% resulted in a 1.3 m/s change in nerve conduction velocity during 8 years. A significantly lowered heart-rate variation during deep breathing (p<0.05) and heart-rate response to standing (p<0.01) was found in patients with HbA1 more than 10% compared to patients with HbA1 less than 10%. This study confirms that the long-term lowering of blood glucose retards the deterioration in nerve conduction velocity observed in the diabetic nerve.

The history of venereology in Norway.

Syphilis became a problem at the beginning of the eighteenth century when a virulent microbe was brought to Norway. This new disease was called "radesyken", a Nordic name for "the wicked disease". "Rade" hospitals were built and this was the beginning of the Norwegian hospital system. Professor Caesar Boeck refused to use mercury in the treatment of syphilis; 2000 of his patients were included in the Oslo study of untreated syphilis. With the use of penicillin and other antibiotics, syphilis and gonorrhoea decreased. More frequent now are the viral diseases, herpes genitalis and condylomata acuminata. HIV is seldom found in the STD clinic in Oslo: only 5-6 HIV-positive persons per year; that is, about 0.09% of all new patients.

Return of the Citizen: A Survey of Recent Work on Citizenship Theory

There has been an explosion of interest in the concept of citizenship among political theorists. In 1978, it could be confidently stated that "the concept of citizenship has gone out of fashion among political thinkers" (van Gunsteren 1978, p. 9). Fifteen years later, citizenship has become the "buzz word" among thinkers on all points of the political spectrum (Heater 1990, p. 293; Vogel and Moran 1991, p. x). There are a number of reasons for this renewed interest in citizenship in the 1990s. At the level of theory, it is a natural evolution in political discourse because the concept of citizenship seems to integrate the demands ofjustice and community membership-the central concepts of political philosophy in the 1970s and 1980s, respectively. Citizenship is intimately linked to ideas of individual entitlement on the one hand and of attachment to a particular community on the other. Thus it may help clarify what is really at stake in the debate between liberals and communitarians. Interest in citizenship has also been sparked by a number of recent political events and trends throughout the world-increasing voter apathy and long-term welfare dependency in the United States, the resurgence of nationalist movements in Eastern Europe, the stresses created by an increasingly multicultural and multiracial population in Western Europe, the backlash against the welfare state in Thatcher's England, the failure of environmental policies that rely on voluntary citizen cooperation, and so forth. These events have made clear that the health and stability of a modern democracy depends, not only on the justice of its 'basic structure' but also on the qualities and attitudes of its citizens:' for example,

Risk factors of stroke incidence and mortality. A 12-year follow-up of the Oslo Study.

The objective of this study was to determine the risk factors of stroke incidence and mortality. Our data are based on a prospective cohort study of men aged 40 to 49 years after 12 years of follow-up. In age-adjusted Cox proportional-hazards regression analysis of 14,403 healthy men, diastolic blood pressure was a stronger predictor for stroke incidence and mortality than systolic blood pressure. Smoking was a stronger predictor of mortality than of incidence. However, there was no dose-response relation among smokers by increased cigarette consumption. Total serum cholesterol was a significant (P < .05) risk factor for stroke mortality and of borderline significance (P = .08) for stroke incidence. Increased physical activity at leisure was associated with reduced stroke incidence but not mortality. The myocardial infarction risk score comprising systolic blood pressure, total serum cholesterol, and daily cigarette smoking was a strong predictor of mortality and incidence. Body mass index, triglycerides, blood glucose, and physical activity at work were not found to be risk factors for stroke. Reduction of blood pressure, cessation of smoking, lowered cholesterol, and increased physical activity at leisure are individual measures to reduce the risk of stroke.

The predictability of risk factors with respect to incidence and mortality of myocardial infarction and total mortality. A 12-year follow-up of the Oslo Study, Norway.

To study the prognostic value of several risk factors on incidence and mortality of myocardial infarction (MI) and total mortality in men. Prospective cohort study of 12 years' follow-up. All men in Oslo aged 40-49 and a 7% sample of men aged 20-39 were invited for screening. Of all 30,025 invited men, of whom 25,015 were aged 40-49, a total of 16,209 men aged 40-49 attended the screening and risk factors were recorded for these men. Incidence of first MI (non-fatal and fatal), mortality of MI, total mortality. When examining the rate ratio of the fifth to the first quintile of risk factors we found that systolic and diastolic blood pressures were stronger predictors for mortality than incidence of MI. The rate ratios (95% confidence interval) of systolic blood pressure were 3.73 (2.56, 5.44) and 2.56 (2.01, 3.25) respectively. For diastolic blood pressure the corresponding rate ratios were 4.14 (2.84, 6.04) and 2.78 (2.18, 3.54). Small differences in the rate ratios for these end-points were found for total serum cholesterol and triglycerides. Daily cigarette smoking versus non-cigarette smoking was a stronger predictor for MI mortality than incidence, with rate ratios of 3.16 (2.45, 4.24) and 2.34 (2.00, 2.79) respectively. The Cox proportional hazards regression analysis confirmed the above results. Total serum cholesterol and triglycerides predicted incidence and mortality of MI equally well. Whereas blood pressure and daily cigarette smoking predicted mortality of MI more strongly.

Goals of blood glucose regulation in prevention of diabetic retinopathy

In several studies a correlation between blood glucose levels and HbA1 (A1c) and the prevalence of retinopathy was documented. Minimal risk for the onset of retinopathy was observed when HbA1 was below 9% from the beginning of diabetes mellitus. This HbA1 (A1c) value corresponds with values above 7 mmol of blood glucose. In intervention trials with near normal values of blood glucose, initially i.e. during the first months of treatment, an increase of microaneurysm was observed. However, in the next 7 years (as was observed in the Oslo Study) the grade of retinopathy in patients was less severe than in patients with HbA1 > 10%. Only 20% of patients treated conventionally can reach the aim of optimal blood glucose regulation. Obviously, in patients with diabetes beginning before the age of 30, this is the reason why the prevalence for the diabetic retinopathy is 40-98% after 15 years of diabetes. Only the functional insulin therapy allows the achievement of optimal blood glucose control in about 40% of patients without increased risk of hypoglycemia. Therefore, this kind of therapy should be the therapy of choice in a great number of type 1 diabetes patients.

The influence of dietary change on hemostatic risk variables.

In the 1970s in the Diet-Antismoking Trial, of the Oslo Study, colleagues and I found that the majority of high-risk men with elevated serum cholesterol and elevated triglyceride concentrations had impaired fibrinolytic capacity. Later on, both our group and others found a similar negative correlation between serum triglyceride levels and fibrinolytic capacity. Furthermore, in a prospective study of dietary intervention in individuals with both elevated cholesterol and triglyceride levels, we found that dietary lowering of serum triglyceride levels was significantly and positively correlated with an improvement in fibrinolytic capacity. In another study, we made the same observation for the coagulation factor VII-phospholipid complex: the more the triglycerides were reduced by diet, the greater was the change in factor VII complex. This correlation was highly significant and independent of changes in serum cholesterol. Platelet function is also influenced by dietary habits, but except for the effects of a fish oil-enriched diet, few data are available about the dietary effects on platelet function. It seems, however, that in individuals with elevated lipid levels and elevated blood pressure, increased platelet reactivity is a highly prevalent finding. Many of the hemostatic risk variables are associated with the so-called "metabolic risk syndrome" characterized by an increase in serum insulin level, together with increased relative body weight, mild hypertension, hyperlipidemia, and physical inactivity. This syndrome can often be influenced favorably by life-style changes. A controlled study with interventions in diet and activity level has just been started by our group.

Macular recovery time, diabetic retinopathy, and clinical variables after 7 years of improved glycemic control.

Effects of long-term improved glucose control on neurosensory retinal function are investigated. Changes in macular recovery of nyctometry (photostress) are assessed in 45 insulin-dependent diabetic patients between study start and after 7 years prospective follow-up (the Oslo Study). Intensified insulin treatment improved glycosylated hemoglobin (HbA1) from 11.7 +/- 2.2% at start to a 7-year cumulative mean of 9.5 +/- 1.5% (p less than 0.0001). Improved macular recovery performance was observed in patients with 7-year mean HbA1 below 10%, compared to a worsening in those above 10% (p less than 0.001-0.02), and non-proliferative retinopathy progressed less in those with HbA1 below 10%, than in those above (p less than 0.01). Macular recovery at study start did not predict progression or outcome of retinopathy 7 years later. Intraocular pressure fell during the 7 years (p less than 0.001) and was cross-sectionally negatively correlated to macular recovery at the 7-year end-point (p less than 0.001-0.002). Macular recovery was not related to age, duration of diabetes, systemic blood pressure, or urinary albumin excretion level. The study indicates that severity of retinopathy, glycemic control and intraocular pressure are interesting covariants to neurosensory dysfunction in diabetes. Furthermore, the study suggests a critical level of long-term blood glucose or retinopathy, or both, above which neurosensory function of macular recovery is significantly reduced.

Long-term glycemie control and kidney function in insulin-dependent diabetes mellitus

In this paper we examined the relationship between blood glucose control and initiation and progression of increased urinary albumin excretion. In this seven year Oslo study 45 insulin-dependent diabetes mellitus patients were initially randomized into three different modes of treatment: continuous subcutaneous insulin infusion (CSII), multiple injections, or two injections a day. After four years, the patients were free to choose their treatment, and therefore the data were analyzed according to mean HbA1 during seven years. The mean HbA1 was 11.2% (2.2) (SD) at start, and 9.5% (1.5) at seven years, which was a significant long-term improvement (P less than 0.001). Eight out of 10 patients with mean seven year HbA1 less than 8.5% improved their albumin excretion rate, and patients with mean HbA1 greater than 10% had an increased albumin excretion rate (from 26 mg/24 hr to 91 mg/24 hr, P less than 0.02). The glomerular filtration rate decreased slightly regardless of mean HbA1 level. Systolic blood pressure increased significantly regardless of mean HbA1. Diastolic blood pressure was unchanged in the patients with mean HbA1 less than 10%, but increased slightly (NS) in patients with HbA1 greater than 10%. We conclude that mean blood glucose as measured by glycosylated hemoglobin is a main determinant in the progression of urinary albumin excretion in insulin dependent diabetics, and near normoglycemia improves urinary albumin excretion.

Blood glucose concentrations and progression of diabetic retinopathy: the seven year results of the Oslo study.

To study insulin dependent diabetic patients for change in non-proliferative retinopathy and its relation to glycaemic control and to various clinical background data. Prospective study with follow up for seven years. Outpatient departments of university hospitals. Glycated haemoglobin concentration; degree of retinopathy. Retinopathy worsened by an overall increase in counts of microaneurysms and haemorrhages from 17 (SD 25) to 45 (58) (p = 0.005). Intensified insulin treatment and home blood glucose monitoring improved concentrations of glycated haemoglobin (HbA1) from 11.2% (2.2%) at the start of the study to a mean of 9.5% (1.5%) over the seven years of the study (p less than 0.0001). A mean value for HbA1 greater than 10% was associated with an increased risk of progression of retinopathy and a mean value less than 8.7% was associated with a diminished risk. Multiple regression analysis identified four independent variables as indicative of outcome of retinopathy after seven years: HbA1 value at baseline; the change in HbA1 from start to the mean level through the seven years; duration of diabetes; and retinopathy at start. Age, blood pressure, and urinary albumin excretion were not related to the presence or progression of retinopathy. Secondary intervention by long term lowering of glycated haemoglobin has a beneficial impact on non-proliferative retinopathy. A four factor regression model can determine patients at high risk of severe retinopathy.

The cardiotoxicity of thiazide diuretics: review of the evidence

Careful consideration of all relevant scientific evidence and a critical assessment of data quality show that thiazide diuretics are not cardiotoxic. Of 12 reported trials only two recorded more coronary heart disease events in thiazide-treated patients than in controls. One of these two was a subgroup of a larger study (Heart Attack Prevention in Primary Hypertension, HAPPHY) which found no difference between thiazide-treated and beta-blocker-treated patients. The other, the Oslo study, was too small to allow valid conclusions. Results from a subgroup in the Multiple Risk Factor Intervention Trial (MRFIT) that appeared to supply evidence for thiazide-related cardiotoxicity are suspect when examined critically. Further evidence from 24- to 28-h ECG monitoring does not support the hypothesis that thiazide diuretics, either in the presence or absence of hypokalemia, increase the frequency or severity of ventricular arrhythmias. Reports of a thiazide-induced intracellular magnesium deficiency as a cause of ventricular arrhythmias have also not been confirmed; the development of arrhythmias in acute myocardial infarction appears to be due to an increase in catecholamine levels rather than hypokalemia. There appears to be little evidence to support the assumption that long-term use of thiazide diuretics aggravates or accelerates atherosclerosis of the coronary arteries; any fall in serum cholesterol appears to be transient. For the great majority of patients with uncomplicated hypertension, without a previous myocardial infarction, congestive heart failure, diabetes mellitus or gout, thiazide diuretics appear to be both safe and effective antihypertensive agents.

‘What are Families For?’: On Family Solidarity and Preference for Help

ABSTRACTNorwegian elderly people today are clearly more aware of public help and services compared to the late 1960s, and a growing number of them prefer public rather than family help. A study in Oslo found that a majority would turn to the public services when in need of long-term help, even when children were living close by. Children or other informal helpers were preferred over the public services only when there was a need for short-term assistance. The growing preference for public help is taken primarily as a response to increased availability of public services, and not as a reflection of weaker inter-generational solidarity.

Review of clinical trials: proving the lipid hypothesis

The Lipid Hypothesis, which states that lowering blood cholesterol levels should significantly reduce the incidence of coronary heart disease (CHD), has been repeatedly tested in primary and secondary intervention trials. Viewed as a whole, it is apparent that the incidence of CHD in treated groups decreased in proportion to the degree of plasma cholesterol reduction. An early study at the Wadsworth Hospital in Los Angeles showed that a diet high in polyunsaturated fat and low in cholesterol reduced the incidence of CHD. The Oslo study of diet and smoking intervention demonstrated a significant decrease in CHD concomitant with a 13% reduction in serum cholesterol achieved through a low saturated-fat diet and cessation of smoking. In the World Health Organization primary prevention trial, clofibrate reduced serum cholesterol by 9% and first clinical episodes of myocardial infarction by 20%. There was a 37% rise in total mortality, but no causal link with clofibrate has been found, and this was not significant when corrected for age at death. A secondary trial, the Coronary Drug Project, demonstrated that oestrogen and dextrothyroxine were clearly toxic. In this trial, niacin produced a 10% fall in serum cholesterol and mortality was 11% lower than in the placebo group after long-term follow-up. The Lipid Research Clinics-Coronary Primary Prevention Trial (LRC-CPPT) found an 8% reduction in plasma cholesterol and a 19% reduction in the incidence of CHD in the group treated with cholestyramine compared with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of hypertension as a risk factor in a prospective study

The association between blood pressure treatment, blood pressure level and mortality, taking other cardiovascular risk factors into account was studied. A 12-year follow-up of a cardiovascular risk factor screening performed by the Oslo study group in Oslo and by ambulatory teams from the National Health Screening Survey in three counties in Norway was done. All men in Oslo and all men and women in the three counties, (age 40-49) participated, of these 33154 men and 16407 women have complete data on blood pressure and treatment, including subjects reporting previous myocardial infarction or stroke. Mortality from coronary heart disease, stroke and all causes by blood pressure treatment and blood pressure level were studied. At the initial screening 1058 men and 817 women reported taking blood pressure medication, of which 201 and 41 died during follow-up. Total number of deaths were 2341 in men and 421 in women, of these 131 deaths in men and 47 in women reporting previous infarction or stroke. Those reporting blood pressure treatment had a marked excess mortality from cardiovascular disease and all causes of death. A J-shaped association between blood pressure and mortality was marked in the treated group, but weak in those not on treatment. It is concluded that blood pressure treatment is associated with excess mortality from all causes. This may indicate that "real life" treatment outcomes are inferior to those reported from controlled clinical trials. There is a J-shaped association between all cause mortality and blood pressure in men on treatment.

Childhood traumas and psychosocial characteristics of 50-year-old men with essential hypertension

The aim of the present study was to describe childhood traumas and other psychosocial characteristics of middle-aged men with never-treated essential hypertension. Hypertensive ( N = 17) and normotensive ( N = 18) 50-yr-old men were selected from the Oslo Study of Cardiovascular Diseases based on their age, sex, blood pressure and otherwise healthy condition without chronic medication. They were interviewed semistructurally by a psychiatrist who was unaware of their blood pressure status. Eleven hypertensives and five normotensives ( p <0.05) had experienced considerable traumas in childhood, e.g. death of a parent, psychotic parent, separation from one or both parents, or beating by an alcoholic father. The hypertensives had fewer siblings and fewer sons than the normotensives ( p <0.05). The normotensives were better educated; 12 had finished at least 12 yr in school as opposed to one hypertensive ( p <0.01). The normotensives' parents ( p <0.05) and spouses ( p <0.001) were better educated than the hypertensives'. The normotensives' yearly income was higher ( p <0.05). The hypertensives showed more Type A behaviour patterns ( p <0.05) and lower Spielberger State Curiosity ( p <0.05). Although the groups were small, they were rigorously characterized. These results therefore suggest that middle-aged men with essential hypertension have more childhood traumas and lower educational and income levels and that these social characteristics are associated with Type A behaviour patterns. The study favours a psychosocial understanding of the pathogenesis of essential hypertension.

Polity and Group Difference: A Critique of the Ideal of Universal Citizenship

An ideal of universal citizenship has driven the emancipatory momentum of modern political life. Ever since the bourgeoisie challenged aristocratic privileges by claiming equal political rights for citizens as such, women, workers, Jews, blacks, and others have pressed for inclusion in that citizenship status. Modern political theory asserted the equal moral worth of all persons, and social movements of the oppressed took this seriously as implying the inclusion of all persons in full citizenship status under the equal protection of the law. Citizenship for everyone, and everyone the same qua citizen. Modern political thought generally assumed that the universality of citizenship in the sense of citizenship for all implies a universality of citizenship in the sense that citizenship status transcends particularity and difference. Whatever the social or group differences among citizens, whatever their inequalities of wealth, status, and power in the everyday activities of civil society, citizenship gives everyone the same status as peers in the political public. With equality conceived as sameness, the ideal of universal citizenship carries at least two meanings in addition to the extension of citizenship to everyone: (a) universality defined as general in opposition to particular; what citizens have in common as opposed to how they differ, and (b) universality in the sense of laws and rules that say the same for all and apply to all in the same way; laws and rules that are blind to individual and group differences. During this angry, sometimes bloody, political struggle in the nineteenth and twentieth centuries, many among the excluded and disadvantaged thought that winning full citizenship status, that is, equal political and civil rights, would lead to their freedom and equality. Now in the late twentieth century, however, when citizenship rights have been formally extended to all groups in liberal capitalist societies, some groups still find themselves treated as second-class citizens. Social movements of oppressed and excluded groups have recently asked why extension of equal citizenship rights has not led to social justice and equality. Part of the answer is

Role of selective alpha 1 blockers in the therapy of hypertension

As millions more patients with mild hypertension are being brought into active drug therapy, the need for effective medications that are safe for long-term use has increased. This is, in part, as a result of the adverse effect on coronary heart disease mortality observed in two of the major therapeutic trials, the Oslo Study and the Multiple Risk Factor Intervention Trial. In both of these, the diuretic-first, stepped-care approach was used. Administration of diuretics is frequently associated with such biochemical abnormalities as hypokalemia, hypercholesterolemia, and hyperglycemia. Thus, the wisdom of the routine use of a diuretic as the first choice of therapy is being questioned. Alternative drugs for initial therapy include beta blockers and selective alpha 1 blockers. With beta blockers, there is a tendency for serum triglycerides to increase and high-density lipoprotein cholesterol to decline, as well as a tendency for an undesirable reduction in cardiac output and an increase in peripheral resistance. Selective alpha 1 blockers, because they lower blood pressure in a hemodynamically more favorable manner and have a tendency to improve the lipid profile, are becoming increasingly attractive as initial therapy for mild hypertension and also as part of the combination needed for more severe disease. The favorable results noted with the new selective alpha 1 blocker terazosin strongly support its addition to the list of preferred drugs for initial therapy.

Effect of intervention on coronary heart disease risk factors in some norwegian counties

Since 1974, a cardiovascular disease screening and intervention program has been carried out in three of the 19 Norwegian counties, namely Finnmark, Sogn og Fjordane, and Oppland. The program strategy was designed to affect both the general population and a defined high-risk group. Procedures were based upon the organization and implementation already well in place through the national tuberculosis prevention program established in the 1940s. The National Health Screening Service performed two screenings, three to five years apart, to identify cardiovascular disease risk factors in all county residents aged 35 to 49 years (age at first screening), and in representative samples of residents aged 20 to 34 years. After each screening, the local general practitioners and public health nurses were responsible for follow-up and intervention against risk factors among defined high-risk persons, as well as for intensified health education in the general population. Between the first and second screenings, a substantial reduction occurred in the level of smoking and in the mean level of total serum cholesterol. A risk score, including values for cholesterol, systolic blood pressure, and cigarette smoking, showed a reduction of approximately 20 percent (in males aged 35 to 49 years). A more detailed analysis of the Finnmark data revealed that the mean reduction was mainly due to a marked reduction within the high-risk group. This occurred particularly with mean cholesterol levels. Since the screening and intervention program was based upon the model established by the Oslo Study, it is reasonable to expect the county program to have had a similar preventive effect. This question will be addressed in future studies.

Coronary heart disease and treatment of hypertension some Oslo study data

The Oslo Hypertension Study began in 1972; patients were followed for an average of 66 months (range: 60 to 78). A total of 785 healthy men, aged 40 to 49, with mild hypertension was randomly assigned to either a drug-treated group or to an untreated control group. Hydrochlorothlazide was used alone in 36 percent of patients, in combination with propranolol in 26 percent, and with methyldopa in 20 percent. Other drugs, Including combinations with hydrochlorothiazide, were used in 18 percent. A total of 95 percent of patients in the drug-treated group received hydrochlorothiazide. Complications of hypertension such as stroke and aneurysm occurred only in the control group. Coronary events were more numerous In the drug-treated group; thus, the total incidence of cardiovascular complications did not significantly differ between the treated and untreated groups. After five and 10 years, total mortality was the same in both groups. However, the coronary heart disease mortality rate at 10 years was significantly greater in the drug-treated group than in the untreated control group (14 versus three, p <0.01). This article presents possible reasons for the failure of antihypertensive drug therapy to prevent coronary heart disease. The adverse effect of diuretics and beta-adrenergic blockers, both on lipid and carbohydrate metabolism, is contrasted with the effect of the alpha-adrenergic blocker prazosin, which has been shown to have no adverse effect on the blood lipid profile. In a short-term trial that was part of the Oslo Study, prazosin was found to reduce total serum cholesterol by 9 percent, low-density lipoprotein and very-low-density lipoprotein cholesterol by 10 percent, and total triglycerides by 16 percent., All these changes are statistically significant.

Oslo study diet and antismoking trial: Results after 102 months

The five year (60-month) results from the Oslo Study Diet and Anti-smoking Trial were published in the Lancet in December 1981. The trial involved 1,232 healthy men, aged 40 to 49 years, at high risk for coronary heart disease, with serum cholesterol values In the range of 7.5 to 9.8 mmol/liter (enzymatic method: 6.9 to 9.0, mean value 7.8 mmol/liter). Eighty percent of the men were daily cigarette smokers at the start of the study, and all participants were normotensive, i.e., systolic blood pressure was less than 150 mm Hg. Subjects were randomly assigned to either a control or intervention group. Follow-up visits were scheduled every six months for the intervention group and yearly for the control group. Once the trial was completed, the regular six-month follow-up visits were discontinued, but eight to nine years (96 to 108 months) after the start of the trial, participants were called for a new follow-up. Risk factors were recorded, and clinical events were diagnosed according to the same procedure as during the trial. The mean serum cholesterol levels in the intervention group remained unchanged three years after the end of the trial, but the cholesterol levels in the control group declined. Daily cigarette smoking increased in the intervention group but remained stable in the control group. At the new follow-up, the difference in incidence of fatal and nonfatal myocardial infarction and sudden coronary death was the same as at the end of the trial three years earlier, yielding significant differences between the two groups for sudden death, total coronary death, and total coronary events. Although the study was not designed to show differences in total mortality, this difference became marginally significant, with 19 deaths in the intervention group and 31 in the control group. It is concluded that although net differences in risk factors between the two groups had been reduced during the three years after the regular intervention period, the significant difference in coronary events and sudden death was maintained.