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VA-HITVeterans Affairs Cooperative HDL (High Density Lipoprotein) Cholesterol Intervention Trial
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Meta-analysis: In a meta-analysis of 5 landmark studies (ACCORD, FIELD, BIP, VA-HIT and HHS) involving 4726 patients, fibrates have been found to reduced CV events significantly by 35% in patients with high TG [greater than or equal to] 204 mg/dL and low HDL [less than or equal to] 34 mg/dL (atherogenic dyslipidaemia).
Significant negative correlations were also observed in the HDL-Atherosclerosis Treatment study (50) and the VA-HIT study (52).
In VA-HIT, for example, a recent subgroup analysis demonstrated that diabetic participants experienced a 41% reduction in risk of coronary death and a 40% reduction in stroke with gemfibrozil, while nondiabetic participants with high fasting insulin levels showed a 35% reduction in coronary death; all of these benefits were of greater magnitude than seen with fibrate therapy in participants with normal insulin, added Dr.
And in both the Helsinki Heart Study and VA-HIT, participants having a body mass index of at least 26 kg/[m.sup.2] experienced a larger cardiovascular risk reduction with fibrate therapy than did thinner subjects, added Dr.
(4-5) In 3 large-scale prospective, placebo-controlled trials (the Helsinki Heart Study, a primary prevention study, and the VA-HIT and Bezafibrate Infarction Prevention trials, both secondary prevention studies), lowering triglycerides and raising HDL concurrently improved outcomes.
Fibrate therapy can reduce CAD risk and slow plaque progression in patients with low HDL levels, as shown in the Helsinki Heart Study and the Lopid Coronary Angiographic Trial (LOCAT), Bezafibrate Coronary Atherosclerosis Intervention Trial (BECAIT), and Veterans Affairs High Density Lipoprotein Cholesterol Intervention Trial study group (VA-HIT).