Gender-based mortality follow-up from the Program on the Surgical Control of the Hyperlipidemias (POSCH) and meta-analysis of lipid intervention trials. Women in POSCH and other lipid trials.
OBJECTIVE
The authors assessed the clinical results of lipid-lowering therapy in women.


BACKGROUND
The Program on the Surgical Control of the Hyperlipidemias (POSCH) has demonstrated that effective lowering of total cholesterol and low-density lipoprotein cholesterol in a postmyocardial infarction population significantly reduces atherosclerotic coronary heart disease (ACHD) mortality, ACHD mortality combined with a new confirmed nonfatal myocardial infarction, and the number of coronary artery bypass grafting and angioplasty procedures performed.


METHODS
A review and meta-analysis were performed of the seven primary or secondary lipid/ atherosclerosis intervention trials-including POSCH-published in the English-language literature that included women and published results in women separate from the results in men or in the entire trial population. The main outcome measure analyzed was overall mortality.


RESULTS
The Scottish Physicians Clofibrate Study, the Newcastle upon Tyne Clofibrate Study, and the Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC I) Trial may have demonstrated a possible benefit in ACHD prognosis from effective lipid intervention in women. The other four available trials did not. The Minnesota Coronary Survey reported a 15.6% increase in overall mortality rate and a 30.6% increase in a combined cardiovascular endpoint rate in the lipid-intervention group. The Upjohn Colestipol Study demonstrated statistically significant reductions in overall and ACHD mortality in the men, but not in the women. The Scandinavian.
Buchwald
H
H
Department of Surgery, University of Minnesota, Minneapolis, USA.
Campos
C T
CT
Boen
J R
JR
Nguyen
P
P
Williams
S E
SE
Lau
J
J
Chalmers
T C
TC
D002784:Cholesterol / Q000097:blood; D018849:Controlled Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007082:Ileum / Q000601:surgery*; D008297:Male; D012307:Risk Factors; D015996:Survival Rate
D000960:Hypolipidemic Agents; D002784:Cholesterol