(Circulation. 2000;102:21.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Secondary Prevention by Raising HDL Cholesterol and Reducing Triglycerides in Patients With Coronary Artery Disease
The Bezafibrate Infarction Prevention (BIP) Study
From the Israeli Society for Prevention of Heart Attacks, Tel-Hashomer, Israel.
Correspondence to the BIP Study Group, Coordinating Center/S. Behar, MD, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel-Hashomer 52621, Israel. E-mail behar{at}post.tau.ac.il
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.
Key Words: lipids • prevention • cardiovascular diseases • triglycerides • lipoproteins, HDL • bezafibrate
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 K. Kuwabara, K. Murakami, M. Todo, T. Aoki, T. Asaki, M. Murai, and J. Yano A Novel Selective Peroxisome Proliferator-Activated Receptor {alpha} Agonist, 2-Methyl-c-5-[4-[5-methyl-2-(4-methylphenyl)-4-oxazolyl]butyl]-1,3-dioxane-r-2-carboxylic acid (NS-220), Potently Decreases Plasma Triglyceride and Glucose Levels and Modifies Lipoprotein Profiles in KK-Ay Mice J. Pharmacol. Exp. Ther., June 1, 2004; 309(3): 970 - 977. [Abstract] [Full Text] [PDF]
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A. Tenenbaum, M. Motro, E. Z. Fisman, E. Schwammenthal, Y. Adler, I. Goldenberg, J. Leor, V. Boyko, L. Mandelzweig, and S. Behar Peroxisome Proliferator-Activated Receptor Ligand Bezafibrate for Prevention of Type 2 Diabetes Mellitus in Patients With Coronary Artery Disease Circulation, May 11, 2004; 109(18): 2197 - 2202. [Abstract] [Full Text] [PDF]
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D. Colquhoun, A. Keech, D. Hunt, I. Marschner, J. Simes, P. Glasziou, H. White, P. Barter, A. Tonkin, and for the LIPID Study Investigators Effects of pravastatin on coronary events in 2073 patients with low levels of both low-density lipoprotein cholesterol and high-density lipoprotein cholesterol: results from the LIPID study Eur. Heart J., May 1, 2004; 25(9): 771 - 777. [Abstract] [Full Text] [PDF]
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J. McKenney New Perspectives on the Use of Niacin in the Treatment of Lipid Disorders Arch Intern Med, April 12, 2004; 164(7): 697 - 705. [Abstract] [Full Text] [PDF]
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 G. Desideri and C. Ferri Authors' Response: Bezafibrate and Simvastatin: Different Beneficial Effects for Different Therapeutic Aims J. Clin. Endocrinol. Metab., April 1, 2004; 89(4): 1978 - 1979. [Full Text] [PDF]
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M. Haim, V. Boyko, U. Goldbourt, A. Battler, and S. Behar Predictive Value of Elevated White Blood Cell Count in Patients With Preexisting Coronary Heart Disease: The Bezafibrate Infarction Prevention Study Arch Intern Med, February 23, 2004; 164(4): 433 - 439. [Abstract] [Full Text] [PDF]
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 S. Fazio and M. F. Linton Apolipoprotein AI as Therapy for Atherosclerosis: Does the Future of Preventive Cardiology Include Weekly Injections of the HDL Protein? Mol. Interv., December 1, 2003; 3(8): 436 - 440. [Abstract] [Full Text] [PDF]
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I. Goldenberg, M. Jonas, A. Tenenbaum, V. Boyko, S. Matetzky, A. Shotan, S. Behar, and H. Reicher-Reiss Current Smoking, Smoking Cessation, and the Risk of Sudden Cardiac Death in Patients With Coronary Artery Disease Arch Intern Med, October 27, 2003; 163(19): 2301 - 2305. [Abstract] [Full Text] [PDF]
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 W. H Reinhart Fibrinogen - marker or mediator of vascular disease? Vascular Medicine, August 1, 2003; 8(3): 211 - 216. [Abstract] [PDF]
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C.M. Ballantyne Raising high-density lipoprotein cholesterol: where are we now? Eur. Heart J. Suppl., June 1, 2003; 5(suppl_D): D17 - D25. [Abstract] [PDF]
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P. Barter Review: Reconsidering the value of fibrates: lessons from the trials The British Journal of Diabetes & Vascular Disease, May 1, 2003; 3(3): 162 - 167. [Abstract] [PDF]
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M. Evans, A. Roberts, and A. Rees Pharmacological management of hyperlipidaemia The British Journal of Diabetes & Vascular Disease, May 1, 2003; 3(3): 204 - 210. [Abstract] [PDF]
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