Reduction in stroke with gemfibrozil in men with coronary heart disease and low HDL cholesterol - The veterans affairs HDL intervention trial (VA-HIT)

Background - A low level of HDL cholesterol has been identified as a risk f actor for stroke in observational studies, Methods and Results - Our objective was to determine whether treatment aime d at raising HDL cholesterol and lowering triglycerides reduces stroke in m en with coronary heart disease and low levels of both HDL and LDL cholester ol. The study was a placebo-controlled, randomized trial conducted in 20 Ve terans Affairs medical centers. A total of 2531 men with coronary heart dis ease, with mean HDL cholesterol 0.82 mmol/L (31.5 mg/dL) and mean LDL chole sterol 2.9 mmol/L(111 mg/dL), were randomized to gemfibrozil 1200 mg/d or p lacebo and were followed up for 5 years, Strokes were confirmed by a blinde d adjudication committee, Relative risks were derived from Cox proportional hazards models. There were 134 confirmed strokes, 90% of which were ischem ic, Seventy-six occurred in the placebo group (9 fatal) and 58 in the gemfi brozil group (3 fatal), for a relative risk reduction, adjusted for baselin e variables, of 31% (95% CI, 2% to 52%, P=0.036), The reduction in risk was evident after 6 to 12 months. Patients with baseline HDL cholesterol below the median may have been more likely to benefit from treatment than those with higher HDL cholesterol. Conclusions - In men with coronary heart disease, low HDL cholesterol, and low LDL cholesterol, gemfibrozil reduces stroke incidence.