Targeting low high-density lipoprotein cholesterol for therapy: lessons from the Veterans Affairs High-density Lipoprotein Intervention Trial.
Results of the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT) showed that therapy with the fibric acid gemfibrozil significantly reduced the incidence of coronary artery disease events in men with known coronary artery disease and a low level of high-density lipoprotein cholesterol (HDL-C). Coronary artery disease event reduction was inversely related to levels of HDL-C achieved with gemfibrozil and, even at relatively low concentrations of HDL-C, coronary artery disease event reduction with gemfibrozil was significantly greater than with placebo. Subjects with a low HDL-C level who were recruited for VA-HIT had a high prevalence of features of the metabolic syndrome with obesity, type 2 diabetes, and hyperinsulinemia. These individuals especially benefited from gemfibrozil, and thus, fibrate therapy may have an increasing role in reducing coronary artery disease risk in a setting of an increasing worldwide prevalence of obesity and diabetes.
Robins
S J
SJ
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA. sjrobins@bu.edu
D008076:Cholesterol, HDL / Q000097:blood* / Q000187:drug effects; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control*; D015248:Gemfibrozil / Q000627:therapeutic use*; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007009:Hypolipoproteinemias / Q000150:complications / Q000188:drug therapy*; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012306:Risk
D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D015248:Gemfibrozil