(Circulation. 1995;92:1779-1785.)
© 1995 American Heart Association, Inc.
Articles |
Some Coronary Risk Factors Related to the Insulin Resistance Syndrome and Treatment With Gemfibrozil
Experience From the Helsinki Heart Study
From the Helsinki Heart Study (L.T.), Helsinki, Finland; and First Department of Medicine (M.M., V.M.), University of Helsinki, Finland.
Correspondence to Leena Tenkanen, PhD, Helsinki Heart Study, Kalliolinnantie 4, SF-00140 Helsinki, Finland.
Background Coronary risk factors related to the insulin resistance syndrome tend to cluster in the same individual. Our previous studies have shown that the dyslipidemia characteristic of this syndrome—low HDL cholesterol and high triglyceride (TG) levels—responds well to treatment with gemfibrozil. Most factors related to insulin-resistance syndrome decrease fibrinolytic capacity, whereas a recent study showed that gemfibrozil improves it and thus may attenuate thrombotic events. To discover whether subjects with clustering of factors related to this resistance might in particular benefit from gemfibrozil, we reanalyzed the Helsinki Heart Study data.
Methods and Results We used Cox regression models to explore the
effects of gemfibrozil among overweight subjects with additional
coronary risk factors in this
hypercholesterolemic male population of 2046
subjects randomized to gemfibrozil and 2035 to placebo. The effect of
gemfibrozil was largely confined to overweight subjects: among those
with body mass index (BMI) >26 kg/m2, the net
difference in cardiac end points between gemfibrozil and placebo groups
was 21 (25 of 1119 versus 46 of 1081), and in those with BMI 
26
kg/m2, it was 7 (31 of 927 versus 38 of 954). The
risk reduction with gemfibrozil was 78% (P=.002) among
those with BMI >26 kg/m2 and
dyslipidemia (TG 
2.3 mmol/L and HDL
cholesterol <1.08 mmol/L). Among those with BMI >26
kg/m2 and three or four of the following factors
present—smoking, sedentary lifestyle, blood pressure 140/90
mm Hg, or blood glucose >4.4 mmol/L—the risk reduction was 68%
(P=.03).
Conclusions Gemfibrozil reduced the coronary risk mainly in overweight subjects with additional risk factors known to contribute to the insulin-resistance syndrome or predispose to it.
Key Words: obesity • exercise • smoking • infarction • lipoproteins
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