The Lipid Research Clinics Coronary Primary Prevention Trial

Abstract

Plasma levels ofhigh-density lipoprotein cholesterol (HDL-C) atentryandsubsequent changes fromthese baseline levels were inversely predictive ofcoronaryheart disease (CHD)end points inhypercholesterolemic men followed for7to10yearsintheLipid Research Clinics Coronary Primary Prevention Trial, especially inthe1907participants receiving cholestyramine. Whenthe men inthis cohort were compared, each1mg/dl increment inbaseline HDL-C(mean44.3mg/dl) was associated with a 5.5%decrement inrisk CHD death ormyocardial infarction (Z= - 5.4), andeach1mg/dl increase frombaseline HDL-Clevels (mean increase = 1.6mg/dl) during the trial wasassociated with a4.4%risk reduction (Z= -2.2). Inthe1899participants receiving placebo, thecorresponding risk decrements were3.4%and1.1%.Although baseline HDL-Clevel (mean = 44.4mg/dl) remained asignificant risk predictor (Z= -3.8)intheplacebo cohort, increases inHDL- C(mean increase 0.5mg/dl) werenotsignificantly predictive ofCHD(Z= -0.6) unless suspect as well asdefinite endpoints were analyzed (Z= - 2.0). Whentheassociations between HDL-C (baseline pluschange) andincidence ofdefinite CHD endpoints within eachtreatment cohort were compared, their difference approached nominal significance (Z= 1.9).Theresults suggest asynergis- ticinteraction, inwhichcholestyramine treatment reduced CHDrisk mostsubstantially inmen main- taining thehighest HDL-Clevels. Circulation 74,No.6,1217-1225, 1986