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

• Published in: Circulation (New York, N.Y.) N.Y.), 2000-07, Vol.102 (1), p.21-27
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; General and cellular metabolism. Vitamins; Medical sciences; Pharmacology. Drug treatments
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.102.1.21

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.