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[Fibrates in the secondary prevention of ischemic cardiopathy]
1Departamento de Endocrinología, Instituto Nacional de Cardiología Ignacio Chávez, INCICH, Juan Badiano No. 1, 14080 México, D.F.
Insights
Increasing high-density lipoprotein cholesterol (HDL-C) and lowering triglycerides showed mixed results in preventing cardiac events. Statins remain primary for coronary heart disease (CHD) patients, but fibrates may benefit specific subgroups.
Area of Science:
- Cardiovascular Medicine
- Clinical Lipidology
Context:
- Established efficacy of low-density lipoprotein cholesterol (LDL-C) reduction in secondary prevention of coronary heart disease (CHD).
- Emerging research on the impact of high-density lipoprotein cholesterol (HDL-C) and triglyceride modulation on cardiovascular outcomes.
Purpose:
- To summarize and compare the characteristics and results of two major secondary prevention trials investigating HDL-C and triglyceride-lowering therapies.
- To evaluate the effectiveness of fibrate therapy in reducing cardiovascular events in patients with CHD.
Summary:
- The Veterans Affairs HDL Intervention Study (VA-HIT) used gemfibrozil, increasing HDL-C by 6.0% and reducing triglycerides by 31%, resulting in a 22% reduction in major CHD events.
- The Bezafibrate Infarction Prevention (BIP) study showed a 6.5% LDL-C reduction, 18% HDL-C increase, and 21% triglyceride reduction, yielding a non-significant 9.4% decrease in CHD events.
- Discrepancies in fibrate therapy effectiveness between the two trials warrant further investigation.
Impact:
- Suggests that statins will likely remain the first-line treatment for most CHD patients.
- Identifies a potential role for fibrates in specific patient subgroups for cardiovascular risk reduction.
- Highlights the complexity of lipid management beyond LDL-C in secondary CHD prevention.
Abstract:
Clinical trials have demonstrated that reduction of low density lipoprotein cholesterol (LDL-C) reduces the incidence of major cardiac events in patients with coronary heart disease (CHD). Recently, two major secondary prevention trials that evaluated the impact of increasing low serum levels of high density lipoprotein cholesterol (HDL-C) and decreasing serum triglycerides on cardiovascular morbidity and mortality were published. This paper briefly summarizes the characteristics and results of these two studies. In the veterans Affairs HDL Intervention Study (VA-HIT), LDL-C was not changed; HDL-C increased 6.0% and triglycerides were reduced 31% by gemfibrozil. The lipid changes in the Bezafibrate Infarction Prevention (BIP) study were LDL-C -6.5%, HDL-C 18%; and triglycerides -21%. In VA-HIT, there was a 22% reduction (p = 0.006) in major CHD events, whereas in the BIP study a nonsignificant reduction of only 9.4% was observed. It is not clear why the effectiveness of fibrate therapy was different in the two studies. From these results it has been suggested that for most CHD patients, the 3-hydroxy-3-methylghutaryl coenzyme A reductase inhibitors (statins) will remain the initial drugs of choice, but fibrates may be of use in a subgroup of patients.