Effect of clofibrate on progression of coronary disease: a prospective angiographic study in man

Lowering blood lipids has been invoked as a means of controlling future coronary events. In this prospective study, the effect of a lipid-reducing agent clofibrate (2 gm. daily) on extent of coronary artery disease was investigated. Forty patients, 32 having aortocoronary bypass, six having Vineberg operations, two having neither, were placed double-blind in placebo (24 patients) and clofibrate (16 patients) groups, and restudied by selective coronary angiography one year later. An additional 24 patients dropped from the study due to adverse drug reactions in eight. Each patient's right, left, anterior descending, and circumflex coronary arteries (with their branches) were separately rated according to degree of obstruction. The clofibrate group showed a significantly greater fall in triglyceride than did the placebo group (minus 13.7 per cent versus plus 2.3 per cent; p equal to 0.45). In the clofibrate group, 19 out of 64 coronary arteries (29.6 per cent) showed progressive coronary narrowing, not significantly different from the placebo group (24 out of 96 coronary arteries narrowed, 25 per cent; p equal to 0.26). No significant differences between drug groups emerged when the data were corrected for degree of fall of blood lipids, initial lipoprotein type, or effect in bypassed versus nonbypassed vessels (p always greater than 0.2). Regression of coronary artery disease was not seen. We conclude that clofibrate did not significantly influence the rate of progression of coronary artery disease in a one-year period.