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(Circulation. 1997;96:2137-2143.)
© 1997 American Heart Association, Inc.
Articles |
Prevention of the Angiographic Progression of Coronary and Vein-Graft Atherosclerosis by Gemfibrozil After Coronary Bypass Surgery in Men With Low Levels of HDL Cholesterol
From the Department of Medicine, Helsinki University Central Hospital (M.H.F., M.S., M.S.N., M-R.T.); Department of Medicine, Oulu University Hospital (H.K., Y.A.K.); and Department of Medicine, Tampere University Hospital (S.M., V.V., A.P.), Finland.
Background Studies have shown that treatment of hyperlipidemia, especially lowering of plasma LDL levels, retards the progression of coronary atherosclerosis and prevents clinical cardiovascular events. No such studies have focused on subjects with low levels of HDL cholesterol.
Methods and Results We randomly assigned 395
post–coronary bypass men, who had an HDL
cholesterol concentration 
1.1 mmol/L and LDL
cholesterol 4.5 mmol/L, to receive gemfibrozil 1200
mg/d or placebo. Coronary angiography was performed at baseline
and after, on average, 32 months of therapy. Changes in
coronary dimensions were assessed by computer-assisted
analysis. Average on-trial serum triglyceride
concentrations were 1.69±0.68 and 1.02±0.37, total
cholesterol 5.48±0.68 and 4.83±0.63, LDL
cholesterol 3.84±0.59 and 3.39±0.56, and HDL
cholesterol 0.88±0.15 and 0.98±0.17 mmol/L in the
placebo and gemfibrozil groups, respectively (mean±SD, each
P<.001). The change in per-patient means of average
diameters of native coronary segments was –0.04±0.11 mm
in the placebo group and –0.01±0.10 mm in the gemfibrozil group
(P=.009). The equivalent changes in minimum luminal
diameters of stenoses were –0.09±0.18 and –0.04±0.15
mm, respectively (P=.002). A similar, albeit nonsignificant,
trend toward treatment benefit was found in the predefined primary
study end point, segments unaffected by grafts and those distal to
graft insertions. In aortocoronary bypass grafts, 23 subjects
(14%) assigned to placebo had new lesions in the follow-up angiogram,
compared with 4 subjects (2%) assigned to gemfibrozil
(P<.001).
Conclusions Gemfibrozil therapy retarded the progression of coronary atherosclerosis and the formation of bypass-graft lesions after coronary bypass surgery in men with low HDL cholesterol as their main lipid abnormality.
Key Words: coronary disease • bypass • lipoproteins • angiography • trials
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