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Raising HDL with bezafibrate improves long-term survival in heart disease patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Treatment with bezafibrate for patients with coronary heart disease appears to reduce long-term mortality, new research indicates. The drug’s ability to raise HDL-cholesterol appears to account, at least in part, for the beneficial effect.

As reported in the Archives of Internal Medicine for March 9, bezafibrate therapy cut long-term mortality by 11% relative to placebo use. However, virtually all of this survival benefit was seen in bezafibrate-treated patients who experienced the greatest increase in HDL-cholesterol levels, Dr. Solomon Behar, from Sheba Medical Center, Tel Hashomer, Israel, and colleagues note.

The results come from a 16-year follow-up analysis of 3026 patients who were enrolled in the Bezafibrate Infarction Prevention (BIP) Trial and were randomized to receive bezafibrate or placebo. The average treatment period was 6.2 years.

An upper-tertile HDL-cholesterol response was defined as an increase in levels of >8 mg/dL. The middle- and lowest-tertile reponses were combined into a lower response defined as an increase of 8 mg/dL or lower.

Upper-tertile response patients had a 22% reduction in long-term mortality (p = 0.008), the report shows, whereas the risk of death in the lower-tertile group was comparable to that of the placebo group.

The cumulative risk of death at 16 years was 32% among upper-tertile responders, while the rates in lower-tertile response group and placebo group was around 37% (p = 0.02).

“These findings suggest that HDL-cholesterol-raising therapy with bezafibrate has important long-term clinical implications that may extend for many years after termination of active treatment with the drug,” the authors state.

Arch Intern Med 2009;169:508-514.