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Prevention of restenosis by bezafibrate after successful coronary angioplasty
S Ishiwata1, S Nakanishi, S Nishiyama
1Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.
Insights
Bezafibrate significantly reduces restenosis after coronary angioplasty in patients with high triglyceride levels. This lipid-lowering drug improves fibrinolytic capacity, lowering risk factors like PAI-1 and triglycerides.
Area of Science:
- Cardiology
- Pharmacology
- Vascular Biology
Background:
- Restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains a clinical challenge.
- Serum lipid levels and coagulation-fibrinolytic factors are implicated in post-PTCA restenosis.
- Investigating bezafibrate's role in preventing restenosis is crucial.
Purpose of the Study:
- To evaluate the efficacy of bezafibrate in preventing restenosis post-PTCA.
- To correlate restenosis incidence with serum lipid profiles and coagulation-fibrinolytic markers.
- To explore bezafibrate's impact on these parameters.
Main Methods:
- Prospective study classifying patients post-PTCA into three groups based on triglyceride levels and bezafibrate treatment.
- Group A: Triglycerides < 150 mg/dl. Group B: Triglycerides ≥ 150 mg/dl treated with bezafibrate. Group C: Triglycerides ≥ 150 mg/dl without lipid-lowering treatment.
- Monitoring restenosis rates and analyzing serum lipids and coagulation-fibrinolytic markers.
Main Results:
- Bezafibrate group showed a significantly lower restenosis rate (14%) compared to control groups (35-55%).
- Elevated triglyceride and fibrinogen levels correlated with restenosis in non-bezafibrate groups.
- Bezafibrate treatment led to decreased triglyceride, fibrinogen, and PAI-1, with increased HDL cholesterol.
Conclusions:
- High triglyceride levels are a risk factor for post-PTCA restenosis.
- Bezafibrate effectively reduces restenosis rates in hypertriglyceridemic patients.
- Improved fibrinolytic capacity, indicated by reduced PAI-1 and favorable lipid changes, likely contributes to bezafibrate's beneficial effect.
Background:
To study the role of bezafibrate in prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA), we evaluated the incidence of restenosis and its correlation with serum lipid levels and effects on the coagulation-fibrinolytic system.
Methods:
Subjects who had undergone successful elective PTCA were classified into three groups based on their triglyceride level and whether or not bezafibrate was administered. Fifty-two patients who had a triglyceride level < 150 mg/dl were classified as group A. Those with a triglyceride level +/- 150 mg/dl were randomly and prospectively allocated to receive either bezafibrate (group B, n = 21), or no lipid-lowering treatment (group C, n = 22). The restenosis rates in all three groups were subsequently monitored and correlated with serum levels of lipids and coagulation-fibrinolytic system markers.
Results:
In the bezafibrate group, three of 21 patients (14%) had restenosis compared with 12 of 22 (55%) in group C and 18 of 52 (35%) in group A. In groups A and C, fibrinogen and triglyceride levels were significantly higher in the patients with restenosis. At the time of re-evaluation, serum triglyceride, fibrinogen, and plasminogen activator inhibitor type 1 (PAI-1) levels were lower and high-density lipoprotein (HDL) cholesterol levels were higher in the bezafibrate group than in group C. By logistic regression analysis, triglyceride and PAI-1 were found to be significant risk factors for postangioplasty restenosis.
Conclusions:
Triglyceride is a risk factor for post-PTCA restenosis, and bezafibrate reduces the post-PTCA restenosis rate in patients with a high triglyceride level. In the bezafibrate group, a significant decrease in PAI-1 was observed in association with a decrease in triglyceride level and an elevation of HDL cholesterol level. This suggests that improvement in fibrinolytic capacity is involved in the mechanism of decrease in the rate of restenosis.