Circulation, Vol 74, 1217-1225, Copyright © 1986 by American Heart Association
DJ Gordon, J Knoke, JL Probstfield, R Superko and HA Tyroler
Plasma levels of high-density lipoprotein cholesterol (HDL-C) at entry and
subsequent changes from these baseline levels were inversely predictive of
coronary heart disease (CHD) end points in hypercholesterolemic men
followed for 7 to 10 years in the Lipid Research Clinics Coronary Primary
Prevention Trial, especially in the 1907 participants receiving
cholestyramine. When the men in this cohort were compared, each 1 mg/dl
increment in baseline HDL-C (mean 44.3 mg/dl) was associated with a 5.5%
decrement in risk of "definite" CHD death or myocardial infarction (Z =
-5.4), and each 1 mg/dl increase from baseline HDL-C levels (mean increase
= 1.6 mg/dl) during the trial was associated with a 4.4% risk reduction (Z
= -2.2). In the 1899 participants receiving placebo, the corresponding risk
decrements were 3.4% and 1.1%. Although baseline HDL-C level (mean = 44.4
mg/dl) remained a significant risk predictor (Z = -3.8) in the placebo
cohort, increases in HDL-C (mean increase 0.5 mg/dl) were not significantly
predictive of CHD (Z = -0.6) unless "suspect" as well as "definite" end
points were analyzed (Z = -2.0). When the associations between HDL-C
(baseline plus change) and incidence of definite CHD end points within each
treatment cohort were compared, their difference approached nominal
significance (Z = 1.9). The results suggest a synergistic interaction, in
which cholestyramine treatment reduced CHD risk most substantially in men
maintaining the highest HDL-C levels.
ARTICLES
High-density lipoprotein cholesterol and coronary heart disease in hypercholesterolemic men: the Lipid Research Clinics Coronary Primary Prevention Trial
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