Secondary Prevention by Raising HDL Cholesterol and Reducing Triglycerides in Patients With Coronary Artery Disease

Ovid Technologies (Wolters Kluwer Health) - Tập 102 Số 1 - Trang 21-27 - 2000
D. Brunner1,2, J Agmon1,2, Elieser Kaplinsky1,2, I Bär1,2, Solomon Behar1,2, Avraham Caspi1,2, Uri Goldbourt1,2, E Graff1,2, Yehezekiel Kaplinsky1,2, Kishon1,2, Henrietta Reicher-Reiss1,2, Avraham Shotan1,2, J. Vollmar1,2, J Waysbort1,2
1Boehringer Mannheim GmbH, Mannheim, Germany
2Center/S. Behar, MD, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel.

Tóm tắt

Background —Coronary heart disease patients with low high-density lipoprotein cholesterol (HDL-C) levels, high triglyceride levels, or both are at an increased risk of cardiovascular events, but the clinical impact of raising HDL-C or decreasing triglycerides remains to be confirmed. Methods and Results —In a double-blind trial, 3090 patients with a previous myocardial infarction or stable angina, total cholesterol of 180 to 250 mg/dL, HDL-C ≤45 mg/dL, triglycerides ≤300 mg/dL, and low-density lipoprotein cholesterol ≤180 mg/dL were randomized to receive either 400 mg of bezafibrate per day or a placebo; they were followed for a mean of 6.2 years. The primary end point was fatal or nonfatal myocardial infarction or sudden death. Bezafibrate increased HDL-C by 18% and reduced triglycerides by 21%. The frequency of the primary end point was 13.6% on bezafibrate versus 15.0% on placebo ( P =0.26). After 6.2 years, the reduction in the cumulative probability of the primary end point was 7.3%, ( P =0.24). In a post hoc analysis in the subgroup with high baseline triglycerides (≥200 mg/dL), the reduction in the cumulative probability of the primary end point by bezafibrate was 39.5% ( P =0.02). Total and noncardiac mortality rates were similar, and adverse events and cancer were equally distributed. Conclusions —Bezafibrate was safe and effective in elevating HDL-C levels and lowering triglycerides. An overall trend in a reduction of the incidence of primary end points was observed. The reduction in the primary end point in patients with high baseline triglycerides (≥200 mg/dL) requires further confirmation.

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Ovid Technologies (Wolters Kluwer Health)

Tập 102 Số 1

21-27

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