Circulation, Vol 69, 313-324, Copyright © 1984 by American Heart Association
JF Brensike, RI Levy, SF Kelsey, ER Passamani, JM Richardson, IK Loh, NJ Stone, RF Aldrich, JW Battaglini and DJ Moriarty
In the National Heart, Lung and Blood Institute Type II Coronary
Intervention Study, patients with Type II hyperlipoproteinemia and coronary
artery disease (CAD) were placed on a low-fat, low-cholesterol diet and
then were randomly allocated to receive either 6 g cholestyramine four
times daily or placebo. This double-blind study evaluated the effects of
cholestyramine on the progression of CAD as assessed by angiography. Diet
alone reduced the low-density lipoprotein cholesterol 6% in both groups.
After randomization, low-density lipoprotein cholesterol decreased another
5% in the placebo group and 26% in the cholestyramine-treated group.
Coronary angiography was performed in 116 patients before and after 5 years
of treatment. CAD progressed in 49% (28 of 57) of the placebo-treated
patients vs 32% (19 of 59) of the cholestyramine-treated patients (p less
than .05). When only definite progression was considered, 35% (20 of 57) of
the placebo- treated patients vs 25% (15 of 59) of the
cholestyramine-treated patients exhibited definite progression; the
difference was not statistically significant. However, when this analysis
was performed with adjustment for baseline inequalities of risk factors,
effect of treatment was more pronounced. Of lesions causing 50% or greater
stenosis at baseline, 33% of placebo-treated and 12% of cholestyramine-
treated patients manifested lesion progression (p less than .05). Similar
analyses with other end points (percent of baseline lesions that
progressed, lesions that progressed to occlusion, lesions that regressed,
size of lesion change, and all cardiovascular end points) all favored the
cholestyramine-treated group, but were not statistically significant. Thus,
although the sample size does not allow a definitive conclusion to be
drawn, this study suggests that cholestyramine treatment retards the rate
of progression of CAD in patients with Type II hyperlipoproteinemia.
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Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II Coronary Intervention Study
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