Background: The high-density lipoprotein(HDL) cholesterol level is a strong predictor of cardiovascular events in epidemiologic studies. Until recently, it has been less extensively studied as a therapeutic target. Ob...Background: The high-density lipoprotein(HDL) cholesterol level is a strong predictor of cardiovascular events in epidemiologic studies. Until recently, it has been less extensively studied as a therapeutic target. Objective: To assess the angiographic and clinical effects of a pharmacologic strategy to increase HDL cholesterol levels. Design: Randomized, double-blind, placebo-controlled trial conducted from 1993 to 1996. Setting: Outpatient specialty clinic of a large U.S. military medical center. Participants: 143 military retirees younger than 76 years of age with low HDL cholesterol levels and angiographically evident coronary disease. Intervention: Gemfibrozil, niacin, and cholestyramine or corresponding placebos, with aggressive dietary and lifestyle intervention at baseline. Measurements: Change from baseline to 30 months and a composite measure of clinical events that included hospitalization for angina, myocardial infarction, transient ischemic attack and stroke, death, and cardiovascular procedures. Results: At baseline, mean(±SD) lipid values were as follows: total cholesterol, 5.1±0.8 mmol/L(196±31 mg/dL); low-density lipoprotein(LDL) cholesterol, 3.3±0.7 mmol/L(128±27 mg/dL); and HDL cholesterol, 0.9±0.2 mmol/L(34±6 mg/dL). Compared with placebo, the pharmacologically treated group experienced a 20%(95%CI, 14.8%to 24.3%) decrease in total cholesterol level, a 36%(CI, 28.4%to 43.5%) increase in HDL cholesterol level, a 26%(CI, 19.1%to 33.7%) decrease in LDL cholesterol level, and a 50%(CI, 40.5%to 59.2%) reduction in triglyceride levels. Focal coronary stenosis increased by 1.4%in the placebo group but decreased by 0.8%in the drug group(difference,-2.2 percentage points [CI,-4.2 to-0.1 percentage points]). A composite cardiovascular event end point was reached in 26%of patients in the placebo group and 13%of those in the drug group(difference, 13.7 percentage points [CI, 0.9 to 26.5 percentage points]). Side effects, particularly flushing and gastrointestinal intolerance, were more common in th展开更多
文摘Background: The high-density lipoprotein(HDL) cholesterol level is a strong predictor of cardiovascular events in epidemiologic studies. Until recently, it has been less extensively studied as a therapeutic target. Objective: To assess the angiographic and clinical effects of a pharmacologic strategy to increase HDL cholesterol levels. Design: Randomized, double-blind, placebo-controlled trial conducted from 1993 to 1996. Setting: Outpatient specialty clinic of a large U.S. military medical center. Participants: 143 military retirees younger than 76 years of age with low HDL cholesterol levels and angiographically evident coronary disease. Intervention: Gemfibrozil, niacin, and cholestyramine or corresponding placebos, with aggressive dietary and lifestyle intervention at baseline. Measurements: Change from baseline to 30 months and a composite measure of clinical events that included hospitalization for angina, myocardial infarction, transient ischemic attack and stroke, death, and cardiovascular procedures. Results: At baseline, mean(±SD) lipid values were as follows: total cholesterol, 5.1±0.8 mmol/L(196±31 mg/dL); low-density lipoprotein(LDL) cholesterol, 3.3±0.7 mmol/L(128±27 mg/dL); and HDL cholesterol, 0.9±0.2 mmol/L(34±6 mg/dL). Compared with placebo, the pharmacologically treated group experienced a 20%(95%CI, 14.8%to 24.3%) decrease in total cholesterol level, a 36%(CI, 28.4%to 43.5%) increase in HDL cholesterol level, a 26%(CI, 19.1%to 33.7%) decrease in LDL cholesterol level, and a 50%(CI, 40.5%to 59.2%) reduction in triglyceride levels. Focal coronary stenosis increased by 1.4%in the placebo group but decreased by 0.8%in the drug group(difference,-2.2 percentage points [CI,-4.2 to-0.1 percentage points]). A composite cardiovascular event end point was reached in 26%of patients in the placebo group and 13%of those in the drug group(difference, 13.7 percentage points [CI, 0.9 to 26.5 percentage points]). Side effects, particularly flushing and gastrointestinal intolerance, were more common in th
