Bloomfield Rubins H, Davenport J, Babikian V, Brass L M, Collins D, Wexler L, Wagner S, Papademetriou V, Rutan G, Robins S J
Center for Chronic Disease Outcomes Research, VAMC, Minneapolis, MN 55417, USA.
Circulation. 2001 Jun 12;103(23):2828-33. doi: 10.1161/01.cir.103.23.2828.
A low level of HDL cholesterol has been identified as a risk factor for stroke in observational studies.
Our objective was to determine whether treatment aimed at raising HDL cholesterol and lowering triglycerides reduces stroke in men with coronary heart disease and low levels of both HDL and LDL cholesterol. The study was a placebo-controlled, randomized trial conducted in 20 Veterans Affairs medical centers. A total of 2531 men with coronary heart disease, with mean HDL cholesterol 0.82 mmol/L (31.5 mg/dL) and mean LDL cholesterol 2.9 mmol/L (111 mg/dL), were randomized to gemfibrozil 1200 mg/d or placebo and were followed up for 5 years. Strokes were confirmed by a blinded adjudication committee. Relative risks were derived from Cox proportional hazards models. There were 134 confirmed strokes, 90% of which were ischemic. Seventy-six occurred in the placebo group (9 fatal) and 58 in the gemfibrozil group (3 fatal), for a relative risk reduction, adjusted for baseline 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.
In men with coronary heart disease, low HDL cholesterol, and low LDL cholesterol, gemfibrozil reduces stroke incidence.
在观察性研究中，低水平的高密度脂蛋白胆固醇已被确定为中风的一个风险因素。
我们的目标是确定旨在提高高密度脂蛋白胆固醇水平并降低甘油三酯的治疗是否能减少患有冠心病且高密度脂蛋白和低密度脂蛋白胆固醇水平均较低的男性的中风发生率。该研究是一项在20个退伍军人事务医疗中心进行的安慰剂对照随机试验。共有2531名患有冠心病的男性参与，其平均高密度脂蛋白胆固醇为0.82毫摩尔/升（31.5毫克/分升），平均低密度脂蛋白胆固醇为2.9毫摩尔/升（111毫克/分升），他们被随机分为每日服用1200毫克吉非贝齐组或安慰剂组，并随访5年。中风由一个盲法判定委员会确认。相对风险来自Cox比例风险模型。共有134例确诊中风，其中90%为缺血性中风。安慰剂组发生76例（9例死亡），吉非贝齐组发生58例（3例死亡），在对基线变量进行调整后，相对风险降低31%（95%可信区间，2%至52%，P = 0.036）。6至12个月后风险降低明显。基线高密度脂蛋白胆固醇低于中位数的患者可能比高密度脂蛋白胆固醇较高的患者更有可能从治疗中获益。
在患有冠心病、高密度脂蛋白胆固醇低和低密度脂蛋白胆固醇低的男性中，吉非贝齐可降低中风发生率。
