Overall mortality, incremental life expectancy, and cause of death at 25 years in the program on the surgical control of the hyperlipidemias.
OBJECTIVE
To present the longest follow-up report of any lipid-atherosclerosis intervention trial.


BACKGROUND
The Program on the Surgical Control of the Hyperlipidemias (POSCH), a secondary, clinical/arteriographic, randomized controlled trial, was the first lipid-atherosclerosis trial to demonstrate unequivocally that low density lipoprotein cholesterol reduction reduced the incidence of coronary heart disease death and myocardial infarction.


METHODS
We report POSCH 25 years follow-up for overall mortality, specific cause of death, and certain subgroup analyses, as well as a prediction for increase in life expectancy derived from the POSCH database, supplemented by the 2006 National Death Index, 1989-2006.


RESULTS
There were 838 patients randomized in POSCH (421 surgery, 417 control). At 25 years follow-up, the difference in the restricted mean survival and the logrank (Mantel-Haenszel) statistic was statistically significant, with survival probabilities of 0.57 (surgery) and 0.51 (controls). Cause of death data indicated a significant increase in cardiovascular deaths in the control group; cancer deaths were also greater in the control group but this was not significant. The most compelling subgroup analysis was a significant increase in survival, starting at 5 years after randomization, in the surgery group for patients with an ejection fraction > or = 50%, with relative probabilities of 0.61 (surgery) and 0.51 (control). The estimated incremental increase in life expectancy over more than 25 years of follow-up was 1.0 year overall and 1.7 years in the cohort with an ejection fraction > or = 50%.


CONCLUSIONS
A 25-year mortality follow-up in POSCH shows statistically significant gains in overall survival, cardiovascular disease-free survival, and life expectancy in the surgery group compared with the control group.
Buchwald
Henry
H
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. buchw001@umn.edu
Rudser
Kyle D
KD
Williams
Stanley E
SE
Michalek
Van N
VN
Vagasky
James
J
Connett
John E
JE
D000328:Adult; D050197:Atherosclerosis / Q000401:mortality / Q000601:surgery; D002423:Cause of Death; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D007581:Jejunoileal Bypass; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume