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Long-term benefit of high-density lipoprotein cholesterol-raising therapy with bezafibrate: 16-year mortality follow-up of the bezafibrate infarction prevention trial.
Arch Intern Med. 2009 Mar 09; 169(5):508-14.AI

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 (< or =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 was significantly 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.

Authors+Show Affiliations

Heart Institute, Sheba Medical Center, Tel-Hashomer, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19273782

Citation

Goldenberg, Ilan, et al. "Long-term Benefit of High-density Lipoprotein Cholesterol-raising Therapy With Bezafibrate: 16-year Mortality Follow-up of the Bezafibrate Infarction Prevention Trial." Archives of Internal Medicine, vol. 169, no. 5, 2009, pp. 508-14.
Goldenberg I, Boyko V, Tennenbaum A, et al. Long-term benefit of high-density lipoprotein cholesterol-raising therapy with bezafibrate: 16-year mortality follow-up of the bezafibrate infarction prevention trial. Arch Intern Med. 2009;169(5):508-14.
Goldenberg, I., Boyko, V., Tennenbaum, A., Tanne, D., Behar, S., & Guetta, V. (2009). Long-term benefit of high-density lipoprotein cholesterol-raising therapy with bezafibrate: 16-year mortality follow-up of the bezafibrate infarction prevention trial. Archives of Internal Medicine, 169(5), 508-14. https://doi.org/10.1001/archinternmed.2008.584
Goldenberg I, et al. Long-term Benefit of High-density Lipoprotein Cholesterol-raising Therapy With Bezafibrate: 16-year Mortality Follow-up of the Bezafibrate Infarction Prevention Trial. Arch Intern Med. 2009 Mar 9;169(5):508-14. PubMed PMID: 19273782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term benefit of high-density lipoprotein cholesterol-raising therapy with bezafibrate: 16-year mortality follow-up of the bezafibrate infarction prevention trial. AU - Goldenberg,Ilan, AU - Boyko,Valentina, AU - Tennenbaum,Alexander, AU - Tanne,David, AU - Behar,Solomon, AU - Guetta,Victor, PY - 2009/3/11/entrez PY - 2009/3/11/pubmed PY - 2009/4/25/medline SP - 508 EP - 14 JF - Archives of internal medicine JO - Arch Intern Med VL - 169 IS - 5 N2 - 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 (< or =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 was significantly 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. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19273782/Long_term_benefit_of_high_density_lipoprotein_cholesterol_raising_therapy_with_bezafibrate:_16_year_mortality_follow_up_of_the_bezafibrate_infarction_prevention_trial_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2008.584 DB - PRIME DP - Unbound Medicine ER -