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Circulation. 2000;102:21-27

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(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

The BIP Study Group

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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