Long-term benefit of high-density lipoprotein cholesterol-raising therapy with Bezafibrate 16-Year mortality follow-up of the Bezafibrate infarction prevention trial

Ilan Goldenberg, Valentina Boyko, Alexander Tennenbaum, David Tanne, Solomon Behar, Victor Guetta

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Major randomized trials of fibrate therapy demonstrate an inverse relationship between on-treatment high-density lipoprotein cholesterol (HDL-C) increments and clinical outcome. We hypothesized that the degree of HDL-C response to bezafibrate is independently associated with subsequent long-term mortality. Methods: The risk of death at 16 years of follow-up among 3026 patients with coronary heart disease allocated to the original bezafibrate (n= 1509) and placebo (n = 1517) arms of the Bezafibrate Infarction Prevention (BIP) trial was related to HDL-C response to bezafibrate therapy, categorized as upper-tertile (>8 mg/dL) or lower-tertile (≤8 mg/dL) on-treatment HDL-C change. Results: Multivariate analysis demonstrated that patients allocated to bezafibrate therapy experienced a significant 11% reduction (P=.06) in the risk of long-term mortality compared with placebo-allocated patients. Mortality reduction among bezafibrate-allocated patients was related to a significant 22% (P=.008) reduction in the risk of death in patients with an upper-tertile HDL-C response to therapy, whereas among patients with a lower HDL-C response, the risk of death was similar to that of the placebo group (hazard ratio, 0.95; P=.43). Accordingly, the cumulative probability of death at 16 years wassignificantly lower among bezafibrate-allocated patients with an upper-tertile HDL-C response (32.1%) compared with the placebo group (37.9%; P=.02), whereas patients with a lower HDL-C response to treatment displayed a mortality rate (36.8%) similar to the placebo group (P = .57). Conclusion: Our findings suggest that HDL-C level-raising therapy with bezafibrate is associated with long-term mortality reduction that may be related to the degree of HDL-C response to treatment.

Original languageEnglish
Pages (from-to)508-514
Number of pages7
JournalArchives of Internal Medicine
Volume169
Issue number5
DOIs
StatePublished - 9 Mar 2009
Externally publishedYes

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