PREVENTION OF THE ANGIOGRAPHIC PROGRESSION OF CORONARY AND VEIN-GRAFTATHEROSCLEROSIS BY GEMFIBROZIL AFTER CORONARY-BYPASS SURGERY IN MEN WITH LOW-LEVELS OF HDL CHOLESTEROL

Background Studies have shown that treatment of hyperlipidemia, especi ally lowering of plasma LDL levels, retards the progression of coronar y atherosclerosis and prevents clinical cardiovascular events. No such studies have focused on subjects with low levels of HDL cholesterol. Methods and Results We randomly assigned 395 post-coronary bypass men, who had an HDL cholesterol concentration less than or equal to 1.1 mm ol/L and LDL cholesterol less than or equal to 4.5 mmol/L, to receive gemfibrozil 1200 mg/d or placebo. Coronary angiography was performed a t baseline and after, on average, 32 months of therapy. Changes in cor onary dimensions were assessed by computer-assisted analysis. Average on-trial serum triglyceride concentrations were 1.69 +/- 0.68 and 1.02 +/- 0.37, total cholesterol 5.45 +/- 0.68 and 4.83 +/- 0.63, LDL chol esterol 3.84 +/- 0.59 and 3.39 +/- 0.56, and HDL cholesterol 0.88 +/- 0.15 and 0.98 +/- 0.17 mmol/L in the placebo and gemfibrozil groups, r espectively (mean +/- SD, each P < .001). The change in per-patient me ans of average diameters of native coronary segments was -0.04 +/- 0.1 1 mm in the placebo group and -0.01 +/- 0.10 mm in the gemfibrozil gro up (P = .009). The equivalent changes in minimum luminal diameters of stenoses were -0.09 +/- 0.18 and -0.04 +/- 0.15 mm, respectively (P = .002). A similar, albeit nonsignificant, trend toward treatment benefi t was found in the predefined primary study end point, segments unaffe cted by grafts and those distal to graft insertions. In aortocoronary bypass grafts, 23 subjects (14%) assigned to placebo had new lesions i n the follow-up angiogram, compared with 4 subjects (2%) assigned to g emfibrozil (P < .001). Conclusions Gemfibrozil therapy retarded the pr ogression of coronary atherosclerosis and the formation of bypass-graf t lesions after coronary bypass surgery in men with low HDL cholestero l as their main lipid abnormality.