(Circulation. 2001;103:2828.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Reduction in Stroke With Gemfibrozil in Men With Coronary Heart Disease and Low HDL Cholesterol
The Veterans Affairs HDL Intervention Trial (VA-HIT)
From the Center for Chronic Disease Outcomes Research, VAMC, Minneapolis (H.B.R.), and Department of Neurology, Park Nicollet Clinic, St Louis Park (J.D.), Minn; Department of Neurology, VAMC (V.B.), and Department of Medicine, Boston University School of Medicine (S.J.R.), Boston, Mass; Department of Neurology, VAMC (L.M.B.), and Department of Veterans Affairs Cooperative Studies Program Coordinating Center (D.C.), West Haven, Conn; Department of Medicine, VAMC, Cincinnati, Ohio (L.W.); Department of Medicine, VAMC, Louisville, Ky (S.W.); Department of Medicine, VAMC, Washington, DC (V.P.); and Department of Medicine, VAMC, Memphis, Tenn (G.R.). Dr Rutan is now at Roudebush VAMC, Indianapolis, Ind.
Background—A low level of HDL cholesterol has been identified as a risk factor for stroke in observational studies.
Methods and Results—Our objective was to determine whether treatment aimed at raising HDL cholesterol and lowering triglycerides reduces stroke in men with coronary heart disease and low levels of both HDL and LDL cholesterol. The study was a placebo-controlled, randomized trial conducted in 20 Veterans Affairs medical centers. A total of 2531 men with coronary heart disease, with mean HDL cholesterol 0.82 mmol/L (31.5 mg/dL) and mean LDL cholesterol 2.9 mmol/L (111 mg/dL), were randomized to gemfibrozil 1200 mg/d or placebo and were followed up for 5 years. Strokes were confirmed by a blinded adjudication committee. Relative risks were derived from Cox proportional hazards models. There were 134 confirmed strokes, 90% of which were ischemic. Seventy-six occurred in the placebo group (9 fatal) and 58 in the gemfibrozil group (3 fatal), for a relative risk reduction, adjusted for baseline variables, of 31% (95% CI, 2% to 52%, P=0.036). The reduction in risk was evident after 6 to 12 months. Patients with baseline HDL cholesterol below the median may have been more likely to benefit from treatment than those with higher HDL cholesterol.
Conclusions—In men with coronary heart disease, low HDL cholesterol, and low LDL cholesterol, gemfibrozil reduces stroke incidence.
Key Words: coronary disease • stroke • gemfibrozil • cholesterol
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