Faculty Collaboration Database

Associations 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. Circulation 1998 Nov 10;98(19):1993-9

Date

11/10/1998

Pubmed ID

9808595

DOI

10.1161/01.cir.98.19.1993

Scopus ID

2-s2.0-0032506254 (requires institutional sign-in at Scopus site)   62 Citations

Abstract

BACKGROUND: Lipid-lowering secondary-prevention trials of coronary artery disease (CAD) have implicated triglyceride-rich lipoproteins as the main determinants of angiographic progression after elevated LDL cholesterol levels have been lowered with therapy. The present study focuses on the lipoprotein determinants of angiographic CAD progression in men with low HDL cholesterol concentration as their main baseline lipid abnormality who underwent 32 months of randomized therapy with gemfibrozil or placebo.

METHODS AND RESULTS: Men who had undergone coronary bypass surgery (n=372) completed a randomized, placebo-controlled study with gemfibrozil 1200 mg/d. They were selected primarily for HDL cholesterol levels that corresponded to the lowest third for middle-aged men. Average baseline lipid and lipoprotein levels were serum triglyceride, 1.60; serum cholesterol, 5.17; ultracentrifugally separated LDL cholesterol, 3.43; HDL2 cholesterol, 0.41; and HDL3 cholesterol, 0. 61 mmol/L. In the gemfibrozil group, these levels were reduced on average by 40%, 9%, and 6% or increased by 5% and 9%, respectively. On-trial IDL and LDL triglyceride and cholesterol levels significantly predicted global angiographic progression, taking into account changes in native segments and in bypass grafts. HDL3 but not HDL2 cholesterol concentration was associated with protection against progression, especially focal disease in native coronary lesions. VLDL was the lipoprotein most predictive of new lesions in vein grafts; IDL was also significantly related.

CONCLUSIONS: This study expands the previous evidence of the triglyceride-rich lipoproteins, especially IDL, as predictors of angiographic progression of CAD but does not negate the significance of mildly elevated LDL levels. Of the HDL subfractions, only HDL3 was protective in this group of men selected for their low initial HDL levels.

Author List

Syvänne M, Nieminen MS, Frick MH, Kauma H, Majahalme S, Virtanen V, Kesäniemi YA, Pasternack A, Ehnholm C, Taskinen MR

Author

Silja Majahalme MD, PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Apolipoproteins
Cholesterol
Cholesterol, HDL
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Disease
Disease Progression
Gemfibrozil
Graft Occlusion, Vascular
Humans
Hypolipidemic Agents
Lipoproteins
Male
Middle Aged
Triglycerides