Table 1.

Randomized, controlled trials evaluating lipid drug therapy for coronary heart disease

Study	Study drug	Subject characteristics	Effect on lipid panel	Effect on CHD	Attribution to changes in major plasma lipid levels
S418,19	Simvastatin 20–40 mg	4444 men and women age 35–70 with angina pectoris or previous MI and TC 213–310, TG ≤ 220	Decreases TC, LDL by 25% and 35% respectively, increases HDL by 8%	Relative risk of MCE reduced by 34%, relative risk of coronary death and all-cause death is 0.58 (CI 0.46–0.73) and 0.70 (CI 0.58–0.85) respectively	Each additional 1% reduction in LDL reduces MCE risk by 1.7% (CI 1.0%–2.4%); each 1% reduction in TC decreases risk for MCE by 1.9% (1.0–2.8); each 1% reduction in HDL decreases risk by 0.8% (0.1–1.5), NS with TG
BIP27	Bezafibrate 400 mg per day	3122 men and women age 45–74 with history of MI or angina; baseline TC 180–250, LDL ≤ 180, HDL ≤ 45, TG ≤ 300	Divided into tertiles; tertile 1 includes subjects with HDL change of ≤3.4 mg/dL, tertile 2 includes subjects with HDL change between +3.41 to +8.02 mg/dL, and tertile 3 includes any subjects with HDL change ≥8.03 mg/dL	NS in cardiac mortality between the bezafibrate and placebo group; significant difference in cardiac mortality between tertile 2 and 3 versus the other subjects	Risk of cardiac mortality decreases by 27% for every 5 mg/dL increase in HDL
VA-HIT28,54	Gemfibrozil 1200 mg per day	2531 men, less than 74 years old with history of CHD; baseline: low HDL (mean 32 mg/dL), low LDL (mean 111 mg/dL); mean TC 175 mg/dL, and mean TG 162 mg/dL	Compared to placebo, gemfibrozil decreases TC, TG by 4%, 31% respectively, increases HDL by 6%, NS LDL in one year	Relative risk reduction of CHD event is 22% (7–35); 24% reduction in combined death from CHD, nonfatal MI, and stroke; NS in all-cause death	Incidence of MI or CHD death is inversely related to HDL, NS with TG and LDL
Helsinki Heart Study21,55	Gemfibrozil 600 mg twice a day	4081 men, 40–55 years old, dyslipidemic asymptomatic, non-HDL > 200 mg/dL	Decreases TC, TG, LDL by 11%, 43%, 10% respectively, increases HDL by about 11% from baseline	Decreases incidence of CHD such as MI and cardiac death by 34% (CI 8.2%–52.6%), no difference in total death	Changes in HDL and LDL are associated with CHD incidence in treatment group; NS TG; proportional hazards model estimates that changes of +8% in HDL, −7% in LDL would reduce CHD incidence by 23%, 15% respectively
LRC-CPPT20	Cholestyramine 24 g/day	3806 men; Asymptomatic middle age men with primary hypercholesterolemia (Type II)	Decreases TC and LDL by 13.4% and 20.3% respectively compared to baseline, 8.5% and 12.6% respectively compared to placebo; treatment group have about 3% higher HDL than placebo	Decreases relative risk of CHD death and nonfatal MI by 19%, no difference in all-cause death	Majority of the reduction in CHD is attributed to decreases in TC and LDL; small increase in HDL accounts for 2% relative risk reduction in CHD

Abbreviations: LDL, low-density lipoprotein, all units in mg/dL; HDL, high-density lipoprotein, all units in mg/dL; TC, total cholesterol, all units in mg/dL; TG, triglyceride, all units in mg/dL; CHD, coronary heart disease; MI, myocardial infarction; MCE, major coronary event; NS, no statistical difference.