title: Bezafibrate for the treatment of dyslipidemia in patients with coronary artery disease: 20-year mortality follow-up of the BIP randomized control trial.
abstract: BACKGROUND
  Recent data support the renewed interest in hypertriglyceridemia as a possible important therapeutic target for cardiovascular risk reduction. This study was designed to address the question of all-cause mortality during extended follow-up of the BIP trial in patients stratified by baseline triglyceride levels.
  
  
  METHODS
  In the BIP trial 3090 patients with proven coronary artery disease were randomized to bezafibrate 400 mg/day or placebo. All-cause mortality data after 20 years of follow-up, were obtained from the National Israeli Population Registry. Patients with hypertriglyceridemia (triglycerides ≥200 mg/dL, n = 458) were equally distributed among the study groups (15 % in both placebo and bezafibrate groups).
  
  
  RESULTS
  During follow-up 1869 patients died (952 in placebo vs. 917 in bezafibrate group). Following multivariate adjustment allocation to bezafibrate was associated with small but significant 10 % mortality risk reduction (HR 0.90; 95 % CI 0.82-0.98, p = 0.026). Variables associated with significantly increased mortality risk were history of a past MI, NYHA class, diabetes, age, higher BMI and glucose level. In patients with hypertriglyceridemia multivariate analysis demonstrated a 25 % all-cause mortality risk reduction associated with allocation to bezafibrate (HR 0.75, CI 95 % 0.60-0.94; p = 0.012). In patients without hypertriglyceridemia bezafibrate had no significant effect on long-term mortality.
  
  
  CONCLUSIONS
  During long-term follow-up bezafibrate-allocated patients experienced a modest but significant 10 % reduction in the adjusted risk of mortality. This effect of bezafibrate was more prominent among patients with baseline hypertriglyceridemia (25 % mortality risk reduction).
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaronarbel@gmail.com.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaronarbel@gmail.com.|The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel. yaronarbel@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaronarbel@gmail.com.
authors.forename: Aharon
authors.initials: A
authors.lastname: Erez
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaronarbel@gmail.com.|The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel. yaronarbel@gmail.com.|Heart Research Follow-up Program, University of Rochester, Rochester, NY, USA. yaronarbel@gmail.com.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Leviev Heart Center, Sheba Medical Center, Tel Aviv, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaronarbel@gmail.com.
authors.forename: Sagit
authors.initials: S
authors.lastname: Benzekry
authors.affiliation: The Israeli Association for Cardiovascular Trials, Tel Hashomer, Israel. yaronarbel@gmail.com.
authors.forename: Nir
authors.initials: N
authors.lastname: Shlomo
authors.affiliation: Cardiovascular Diabetology Research Foundation, Holon, Israel. yaronarbel@gmail.com.
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.affiliation: Cardiovascular Diabetology Research Foundation, Holon, Israel. yaronarbel@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
mesh_terms: D000368:Aged; D001629:Bezafibrate / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D057194:Intention to Treat Analysis; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D000960:Hypolipidemic Agents; D014280:Triglycerides; D001629:Bezafibrate