Relation of Gemfibrozil Treatment and Lipid Levels With Major Coronary Events
JAMAPublished 28 March 2001
Sander J. Robins, Dorothea Collins, Janet Wittes, Vasilios Papademetriou, Prakash Deedwania, Ernst J. Schaefer
Citations922
SJR quartileQ1
SJR score5.35
SNIP10.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Concentrations of HDL-C achieved with gemfibrozil treatment predicted a significant reduction in CHD events in patients with low LDL-C levels, however, the change in HDL- C levels only partially explained the beneficial effect of gem fibroZil.
Abstract
Concentrations of HDL-C achieved with gemfibrozil treatment predicted a significant reduction in CHD events in patients with low HDL-C levels. However, the change in HDL-C levels only partially explained the beneficial effect of gemfibrozil.
Keywords
Medicine
Clinical ChemistryEstimation of the Concentration of Low-Density Lipoprotein Cholesterol in Plasma, Without Use of the Preparative Ultracentrifuge
32,475 Citations1972William T. Friedewald, Robert I. Levy +1 more
A method for estimating the cholesterol content of the serum low-density lipoprotein fraction (Sf0-20) is presented and comparison of this suggested procedure with the more direct procedure, in which the ultracentrifuge is used, yielded correlation coefficients of .94 to .99.
New England Journal of MedicineThe Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels
7,491 Citations1996Frank M. Sacks, Marc A. Pfeffer +10 more
It is demonstrated that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels and was also greater in patients with higher pretreatment levels of LDL cholesterol.
New England Journal of MedicinePrevention of Cardiovascular Events and Death with Pravastatin in Patients with Coronary Heart Disease and a Broad Range of Initial Cholesterol Levels
5,299 Citations1998The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group
Pravastatin therapy reduced mortality from coronary heart disease and overall mortality, as compared with the rates in the placebo group, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.
New England Journal of MedicineHelsinki Heart Study: Primary-Prevention Trial with Gemfibrozil in Middle-Aged Men with Dyslipidemia
3,875 Citations1987M. H. Frick, Olli Elo +17 more
Results are in accord with two previous trials with different pharmacologic agents and indicate that modification of lipoprotein levels with gemfibrozil reduces the incidence of coronary heart disease in men with dyslipidemia.
New England Journal of MedicineGemfibrozil for the Secondary Prevention of Coronary Heart Disease in Men with Low Levels of High-Density Lipoprotein Cholesterol
3,444 Citations1999Hanna E. Bloomfield, Sander J. Robins +10 more
Gemfibrozil therapy resulted in a significant reduction in the risk of major cardiovascular events in patients with coronary disease whose primary lipid abnormality was a low HDL cholesterol level, suggesting that the rate of coronary events is reduced by raising HDL cholesterol levels and lowering levels of triglycerides without lowering LDL cholesterol levels.
CirculationHigh-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies.
3,187 Citations1989David J. Gordon, Jeffrey L. Probstfield +7 more
A consistent inverse relation of high-density lipoprotein cholesterol levels and coronary heart disease event rates was apparent in BRHS as well as in the four American studies.
The LancetPLASMA-HIGH-DENSITY-LIPOPROTEIN CONCENTRATION AND DEVELOPMENT OF ISCHÆMIC HEART-DISEASE
2,633 Citations1975George J. Miller, N.E. Miller
The body cholesterol pool increases with decreasing plasma-high-density-lipoprotein (H.D.L.) but is unrelated to the plasma concentrations of total cholesterol and other lipoproteins, and it is proposed that a reduction of plasma-H.H.L.D., is reduced in several conditions associated with an increased risk of future ischaemic heart-disease, by impairing the clearance of cholesterol from the arterial wall.
New England Journal of MedicineRegression of Coronary Artery Disease as a Result of Intensive Lipid-Lowering Therapy in Men with High Levels of Apolipoprotein B
2,166 Citations1990Greg Brown, John J. Albers +8 more
In men with coronary artery disease who were at high risk for cardiovascular events, intensive lipid-lowering therapy reduced the frequency of progression of coronary lesions, increased the frequencyof regression, and reduced the incidence of cardiovascular events.
CirculationMechanism of Action of Fibrates on Lipid and Lipoprotein Metabolism
1,787 Citations1998Bart Staels, Jean Dallongeville +4 more
Both enhanced catabolism of triglyceride-rich particles and reduced secretion of VLDL underlie the hypotriglyceridemic effect of fibrates, whereas their effect on HDL metabolism is associated with changes in HDL apolipoprotein expression.
CirculationSecondary Prevention by Raising HDL Cholesterol and Reducing Triglycerides in Patients With Coronary Artery Disease
1,280 Citations2000
Bezafibrate was safe and effective in elevating HDL-C levels and lowering triglycerides and an overall trend in a reduction of the incidence of primary end points was observed.
New England Journal of MedicineA Prospective Study of Cholesterol, Apolipoproteins, and the Risk of Myocardial Infarction
1,167 Citations1991Meir J. Stampfer, Frank M. Sacks +3 more
Both HDL cholesterol and HDL2 levels were associated with a substantially decreased risk of myocardial infarction, but the HDL3 level was the strongest predictor; the relative risk was 0.3 (95 percent confidence interval, 0.2 to 0.6).
JAMALipid Alterations and Decline in the Incidence of Coronary Heart Disease in the Helsinki Heart Study
942 Citations1988Vesa Manninen
The results of this study suggest that both elevating HDL and lowering LDL cholesterol levels are effective in the primary prevention of CHD.
Acta Medica ScandinavicaReduction of Mortality in the Stockholm Ischaemic Heart Disease Secondary Prevention Study by Combined Treatment with Clofibrate and Nicotinic Acid
689 Citations1988Lars A. Carlson, G. Rosenhamer
The fact that the decrease in IHD deaths was directly related to the degree of serum triglyceride lowering indicates that it was the drug effect on serum lipids that was responsible for the beneficial effect of the treatment.
CirculationRelation Between Baseline and On-Treatment Lipid Parameters and First Acute Major Coronary Events in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS)
567 Citations2000Antonio M. Gotto, Edwin J. Whitney +10 more
People with average TC and LDL-C levels and below-average HDL-C may obtain significant clinical benefit from primary-prevention lipid modification, and on-treatment apoB, especially when combined with apoAI to form the apOB/AI ratio, may be a more accurate predictor than LDL- C of risk for first AMCE.
Clinica Chimica ActaAutomated enzymatic standardized lipid analyses for plasma and lipoprotein fractions
528 Citations1987Judith McNamara, Ernst J. Schaefer
Automated enzymatic methods for cholesterol, triglycerides and free glycerol determinations, as well as a dextran sulfate-Mg2+ procedure for separation of high density lipoproteins (HDL) with standardization are described.
Current Opinion in LipidologyPeroxisome proliterator-activated receptor-alpha activators regulate genes governing lipoprotein metabolism, vascular inflammation and atherosclerosis
425 Citations1999Jean‐Charles Fruchart, Patrick Duriez +1 more
The peroxisome proliferator-activated receptors (PPARs) [alpha, delta (beta) and gamma] form a subfamily of the nuclear receptor gene family, activated by fatty acids and derivatives.
Arteriosclerosis Thrombosis and Vascular BiologyIsolated Low HDL Cholesterol As a Risk Factor for Coronary Heart Disease Mortality
390 Citations1997Uri Goldbourt, Shlomit Yaari +1 more
The results indicate that an increased risk of CHD death is associated with abnormally low HDL-C for cholesterol ranges both below and above 5.2 mmol/L, and would tend to support the recommended practice of considering a TC level of 5.
Journal of the American College of CardiologyLipoprotein cholesterol, apolipoprotein A-I and B and lipoprotein (a) abnormalities in men with premature coronary artery disease
334 Citations1992Jacques Genest, Judith McNamara +7 more
Stepwise discriminant analysis indicates that smoking, hypertension, decreased apolipoprotein A-I, increased apoliprotein B, increased Lp(a) and diabetes are all significant factors in descending order of importance in distinguishing patients with coronary artery disease from normal control subjects.
The American Journal of CardiologyRange of serum cholesterol values in the population developing coronary artery disease
288 Citations1995William B. Kannel
In the Framingham Study cohort, those with elevated serum total cholesterol had an increased risk of adverse outcomes whether healthy or with CAD, and the average cholesterol levels at which CAD events occurred were substantially higher in women and decreased with age.
CirculationPrediction of angiographic change in native human coronary arteries and aortocoronary bypass grafts. Lipid and nonlipid factors.
277 Citations1990David H. Blankenhorn, Petar Alaupovic +3 more
Both drug- and placebo-treated group findings point to an important role for triglyceride-rich lipoproteins in progression and regression of human atherosclerosis.
The American Journal of CardiologyDistribution of lipids in 8,500 men with coronary artery disease
239 Citations1995Hanna E. Bloomfield, Sander J. Robins +11 more
Black men with CAD have substantially higher HDL cholesterol than white men, almost 90% of male patients with CAD are candidates for dietary intervention and > 40% may need medications to lower LDL cholesterol, and 40% of patients without a definite indication for cholesterol-lowering medications have low levels of HDL cholesterol.
Clinical ChemistryReference intervals for plasma apolipoprotein A-1 determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study
227 Citations1996John H. Contois, Judith McNamara +4 more
An apo A-I concentration of 1.20 g/L roughly corresponded to the 25th percentile value in men and the 5th percentile in women, and subjects with a concentration below this value were significantly more likely to have CHD than subjects wit a higher concentration (P<0.001).
CirculationInfluence of Low HDL on Progression of Coronary Artery Disease and Response to Fluvastatin Therapy
198 Citations1999Christie M. Ballantyne, J. Alan Herd +6 more
Although the predominant lipid-modifying effect of fluvastatin is to decrease LDL-C, patients with low HDL-C received the greatest angiographic and clinical benefit; among low-HDL-C patients, fluVastatin patients had improved event-free survival compared with placebo patients.
Journal of Clinical InvestigationMechanism of action of gemfibrozil on lipoprotein metabolism.
186 Citations1985Keijiro Saku, Peter S. Gartside +2 more
Data suggest that gemfibrozil increases plasma HDL levels by stimulating their synthesis, and may be significant in increasing tissue cholesterol removal in patients with primary familial endogenous hypertriglyceridemia with fasting chylomicronemia.
Arteriosclerosis Thrombosis and Vascular BiologyLipoprotein Subclasses in the Monitored Atherosclerosis Regression Study (MARS)
175 Citations1996Wendy J. Mack, Ronald M. Krauss +1 more
Relationships between lipoprotein subclasses and progression of coronary artery atherosclerosis is investigated using data from the Monitored Atherosclerosis Regression Study, an angiographic trial of middle-aged men and women randomized to lovastatin or placebo to provide further evidence for the importance of triglyceride-rich lipoproteins in the progressionof coronary artery disease.
Journal of the American College of CardiologyTreatment effects on serum lipoprotein lipids, apolipoproteins and low density lipoprotein particle size and relationships of lipoprotein variables to progression of coronary artery disease in the Bezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT)
164 Citations1998Giacomo Ruotolo, Carl-Göran Ericsson +7 more
The results suggest that the effect of bezafibrate on progression of focal coronary atherosclerosis could be at least partly attributed to a rise in HDL3 cholesterol and a decrease in the total number of apo B-containing lipoproteins.
MetabolismIndependent associations between plasma lipoprotein subfraction levels and the course of coronary artery disease in the St. Thomas' Atherosclerosis Regression Study (STARS)
149 Citations1993Gerald F. Watts, Sundhiya Mandalia +4 more
It is suggested that LDL3 is the plasma lipoprotein subfraction that exerts the single most powerful effect on the course of CAD in middle-aged men with hypercholesterolemia.
AtherosclerosisTriglycerides and HDL-cholesterol as risk factors for ischemic heart disease. Results from the Québec cardiovascular study
132 Citations1996Benoı̂t Lamarche, Jean‐Pierre Després +4 more
The independent interpretation of cholesterol, TG or LDL-C levels may lead to an inadequate prediction of risk, as a large number of IHD patients showed a cluster of risk factors which included low HDL-C concentrations.
The American Journal of CardiologyRationale and design of the Department of Veterans Affairs high-density lipoprotein cholesterol Intervention Trial (HIT) for secondary prevention of coronary artery disease in men with low high-density lipoprotein cholesterol and desirable low-density lipoprotein cholesterol
98 Citations1993Hanna E. Bloomfield, Sander J. Robins +8 more
The rationale and design of the Department of Veterans Affairs HDL Intervention Trial (HIT), a multicenter, randomized, controlled clinical trial designed to determine whether lipid therapy reduces the combined incidence of CAD death and nonfatal myocardial infarction in men with established CAD, are described.
CirculationAssociations Between Lipoproteins and the Progression of Coronary and Vein-Graft Atherosclerosis in a Controlled Trial With Gemfibrozil in Men With Low Baseline Levels of HDL Cholesterol
72 Citations1998Mikko Syvänne, Markku S. Nieminen +8 more
Previous evidence of the triglyceride-rich lipoproteins, especially IDL, as predictors of angiographic progression of CAD is expanded but does not negate the significance of mildly elevated LDL levels.
The American Journal of CardiologyThe veterans affairs high-density lipoprotein intervention trial: Baseline characteristics of normocholesterolemic men with coronary artery disease and low levels of high-density lipoprotein cholesterol
64 Citations1996Hanna E. Bloomfield, Sander J. Robins +1 more
The baseline characteristics of the 2,531 patients with coronary artery disease enrolled in the Veterans Affairs Cooperative Studies Program High Density Lipoprotein Intervention Trial are described.
AtherosclerosisEffect of gemfibrozil on the concentration and composition of serum lipoproteins A controlled study with special reference to initial triglyceride levels
39 Citations1990Matti Mänttäri, Pekka Koskinen +4 more
Gemfibrozil, in addition to changing the absolute amounts of lipoprotein lipids, also normalized the qualitative abnormalities associated with hypertriglyceridemia.
Clinical ChemistryModification of the dextran-Mg2+ high-density lipoprotein cholesterol precipitation method for use with previously frozen plasma
35 Citations1994Judith McNamara, C M Huang +6 more
A modification was developed that dilutes thawed samples by 35% and increases dextran-Mg2+ reagent to 15% of sample volume and those for the modified method were not different from fresh samples, and only one specimen required additional steps to produce a clear supernate.
AtherosclerosisEffect of gemfibrozil treatment in hypercholesterolemia on low density lipoprotein (LDL) subclass distribution and LDL-cell interaction
32 Citations1995Guido Franceschini, Maria Rosa Lovati +6 more
Findings indicate that gemfibrozil causes significant changes in LDL structure that do not, however, affect the LDL interaction with peripheral cells.
AtherosclerosisChange in composition of high density lipoprotein during gemfibrozil therapy
22 Citations1987Alexander Sorisky, Teik Chye Ooi +4 more
Investigation of the high density lipoprotein cholesterol response in 20 middle-aged males during a 12-week course of gemfibrozil suggests a change in composition of HDL, i.e. cholesterol enrichment and triglyceride depletion.
Current Opinion in LipidologyThe role of native apolipoprotein B-containing lipoproteins in atherosclerosis
16 Citations1994Ephraim Sehayek, Shlomo Eisenberg
A new development that involves the interactions of lipoprotein, enzymes, apolipoproteins, and cell-surface heparan sulphate may explain, at least in part, the enhanced atherogenicity of theselipoproteins.
Biochemical Medicine and Metabolic BiologyMechanism of the Gemfibrozil-Induced Decrease in the Transfer of Cholesterol Esters from High Density Lipoproteins to Very Low and Low Density Lipoproteins
13 Citations1994Gabriel Ponsin, Gilbert Girardot +1 more
Investigation of the changes induced by gemfibrozil administration on the unidirectional transfer of radiolabeled EC from high density lipoproteins (HDL) to very low (VLDL) and low density cholesterol (LDL), accompanied by a decrease in the HDL-dependent transfer of EC, led to a decrease of the triglyceride (TG)/EC ratio in HDL and an increase of the HDL viscosity.
European Journal of Clinical InvestigationReverse cholesterol transport: relationship between free cholesterol uptake and HDL3 in normolipidaemic and hyperlipidaemic subjects
7 Citations1993M. Castro Cabezas, G. Paul H. van Heusden +5 more
It is concluded that HDL3 is involved in the early steps of RCT and low HDL3 levels may result in less efficient RCT in hypertriglyceridemia.