Subgroup analyses showed the benefit of fibrates on the primary composite outcome to be consistent irrespective of age , gender , and diabetes mellitus .
Moderate evidence showed that the fibrate class can be effective in the secondary prevention of composite outcome of non-fatal stroke , non-fatal MI , and vascular death .
However , this beneficial effect relies on the inclusion of clofibrate data , a drug that was discontinued in 2002 due to its unacceptably large adverse effects .
BACKGROUND Fibrates are a class of drugs characterised by mainly lowering high triglyceride , raising high-density lipoprotein ( HDL ) cholesterol , and lowering the small dense fraction of low-density lipoprotein ( LDL ) cholesterol .
Their efficacy for secondary prevention of serious vascular events is unclear , and to date no systematic review focusing on secondary prevention has been undertaken .
OBJECTIVES To assess the efficacy and safety of fibrates for the prevention of serious vascular events in people with previous cardiovascular disease ( CVD ) , including coronary heart disease and stroke .
A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction.
BACKGROUND The independent contributions of subfractions of high-density lipoprotein ( HDL ) cholesterol ( HDL2 and HDL3 ) and apolipoproteins in predicting the risk of myocardial infa rct ion are unclear . Prospect i ve data are sparse , but HDL2 is widely believed to be a more important predictor than HDL3 . METHODS Blood sample s were collected at base line from 14,916 men ( ages , 40 to 84 years ) who were participants in the Physicians ' Health Study . After five years of follow-up , plasma sample s from 246 men with new myocardial infa rct ion ( case subjects ) were analyzed together with specimens from 246 men matched to them for age and smoking status who had not had a myocardial infa rct ion . RESULTS The levels of total cholesterol and apolipoprotein B-100 were significantly associated with an increased risk of myocardial infa rct ion ( data on levels of low-density lipoprotein cholesterol were unavailable ) . Both HDL cholesterol and HDL2 levels were associated with a substantially decreased risk of myocardial infa rct ion , but the HDL3 level was the strongest predictor ; the relative risk was 0.3 ( 95 percent confidence interval , 0.2 to 0.6 ) for those in the fifth of the group with the highest HDL3 levels , as compared with the fifth with the lowest levels . The benefit of a higher HDL cholesterol level was most pronounced among those with lower total cholesterol levels . Levels of apolipoprotein A-I and apolipoprotein A-II were also associated with decreased risk . However , the levels of HDL subfractions and apolipoproteins did not add significantly to the value of a multivariate model that included the ratio of total to HDL cholesterol in predicting myocardial infa rct ion , whereas that ratio remained a significant independent predictor of risk . After adjustment for other risk factors , a change of one unit in the ratio of total to HDL cholesterol was associated with a 53 percent change in risk ( 95 percent confidence interval , 26 percent to 85 percent ) . CONCLUSIONS This study underscores the importance of HDL cholesterol in predicting the risk of myocardial infa rct ion and demonstrates protective effects of both the HDL3 and HDL2 subfractions of HDL cholesterol . We found little or no predictive value for the levels of apolipoproteins A-I , A-II , and B or HDL subfractions after conventional risk factors and the ratio of total to HDL cholesterol were considered
Subgroup analyses showed the benefit of fibrates on the primary composite outcome to be consistent irrespective of age , gender , and diabetes mellitus .
Moderate evidence showed that the fibrate class can be effective in the secondary prevention of composite outcome of non-fatal stroke , non-fatal MI , and vascular death .
However , this beneficial effect relies on the inclusion of clofibrate data , a drug that was discontinued in 2002 due to its unacceptably large adverse effects .
BACKGROUND Fibrates are a class of drugs characterised by mainly lowering high triglyceride , raising high-density lipoprotein ( HDL ) cholesterol , and lowering the small dense fraction of low-density lipoprotein ( LDL ) cholesterol .
Their efficacy for secondary prevention of serious vascular events is unclear , and to date no systematic review focusing on secondary prevention has been undertaken .
OBJECTIVES To assess the efficacy and safety of fibrates for the prevention of serious vascular events in people with previous cardiovascular disease ( CVD ) , including coronary heart disease and stroke .