Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: The bezafibrate infarction prevention (BIP) study

S. Behar*, D. Brunner, E. Kaplinsky, L. Mandelzweig, M. Benderly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background - Coronary heart disease patients with low high-density lipoprotein cholesterol (HDL-C) levels, high triglyceride levels, or both are at an increased risk of cardiovascular events, but the clinical impact of raising HDL-C or decreasing triglycerides remains to be confirmed. Methods and Results - In a double-blind trial, 3090 patients with a previous myocardial infarction or stable angina, total cholesterol of 180 to 250 mg/dL, HDL-C ≤45 mg/dL, triglycerides ≤300 mg/dL, and low-density lipoprotein cholesterol ≤180 mg/dL were randomized to receive either 400 mg of bezafibrate per day or a placebo; they were followed for a mean of 6.2 years. The primary end point was fatal or nonfatal myocardial infarction or sudden death. Bezafibrate increased HDL-C by 18% and reduced triglycerides by 21%. The frequency of the primary end point was 13.6% on bezafibrate versus 15.0% on placebo (P=0.26). After 6.2 years, the reduction in the cumulative probability of the primary end point was 7.3%, (P=0.24). In a post hoc analysis in the subgroup with high baseline triglycerides (≥200 mg/dL), the reduction in the cumulative probability of the primary end point by bezafibrate was 39.5% (P=0.02). Total and noncardiac mortality rates were similar, and adverse events and cancer were equally distributed. Conclusions - Bezafibrate was safe and effective in elevating HDL-C levels and lowering triglycerides. An overall trend in a reduction of the incidence of primary end points was observed. The reduction in the primary end point in patients with high baseline triglycerides (≥200 mg/dL) requires further confirmation.

Original languageEnglish
Pages (from-to)21-27
Number of pages7
JournalCirculation
Volume102
Issue number1
DOIs
StatePublished - 4 Jul 2000
Externally publishedYes

Keywords

  • Bezafibrate
  • Cardiovascular diseases
  • Lipids
  • Lipoproteins, HDL
  • Prevention
  • Triglycerides

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