Document Detail


Relation of clinical benefit of raising high-density lipoprotein cholesterol to serum levels of low-density lipoprotein cholesterol in patients with coronary heart disease (from the Bezafibrate Infarction Prevention Trial).
MedLine Citation:
PMID:  19101227     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Low high-density lipoprotein (HDL) cholesterol is a strong independent predictor of cardiovascular risk. The present study was designed to assess the relation between the clinical response to HDL cholesterol modification and serum levels of low-density lipoprotein (LDL) cholesterol in patients with coronary artery disease (CAD). The risk for a major cardiac event (defined as nonfatal myocardial infarction or cardiac death) during a median 7.9-year follow-up period in 3,020 patients with CAD enrolled in the Bezafibrate Infarction Prevention (BIP) trial was related to changes in lipid levels during the study. Baseline LDL cholesterol levels were categorized according to National Cholesterol Education Program Adult Treatment Panel III criteria. Multivariate analysis demonstrated that the benefit of HDL cholesterol increase was most pronounced in patients with low baseline LDL cholesterol (<or=129 mg/dl; 29% risk reduction per 5 mg/dl increment in HDL cholesterol, p = 0.02), intermediate in patients with intermediate LDL cholesterol (130 to 159 mg/dl; 13% risk reduction per 5 mg/dl increment in HDL cholesterol, p = 0.03), and nonsignificant in patients with high LDL cholesterol (>or=160 mg/dl; hazard ratio 0.94, 95% confidence interval 0.75 to 1.17, p = 0.14). A similar relation was shown for risk reduction-associated triglyceride decrements, whereas the benefit of LDL cholesterol reduction was more pronounced in patients with baseline LDL cholesterol >or=130 mg/dl. In conclusion, these data suggest that the clinical response to HDL cholesterol and triglyceride modification is inversely related to baseline LDL cholesterol levels. Thus, combined assessment of baseline and follow-up lipid levels to direct therapeutic goals in patients with CAD may provide incremental prognostic information to secondary prevention that is based solely on LDL cholesterol modification.
Authors:
Ilan Goldenberg; Michal Benderly; Roy Sidi; Valentina Boyko; Alexander Tenenbaum; David Tanne; Shlomo Behar
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2008-10-10
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2008-12-22     Completed Date:  2009-01-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  41-5     Citation Subset:  AIM; IM    
Affiliation:
Heart Institute, Sheba Medical Center, Tel Hashomer, Israel. ilan.goldenberg@heart.rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Antilipemic Agents / therapeutic use*
Bezafibrate / therapeutic use*
Biological Markers / blood
Cholesterol, HDL / blood*
Cholesterol, LDL / blood*
Coronary Disease / blood*,  complications,  mortality
Female
Follow-Up Studies
Humans
Israel / epidemiology
Male
Middle Aged
Myocardial Infarction / blood,  etiology,  prevention & control*
Prognosis
Prospective Studies
Survival Rate / trends
Time Factors
Chemical
Reg. No./Substance:
0/Antilipemic Agents; 0/Biological Markers; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 41859-67-0/Bezafibrate

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