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Gemfibrozil Reduces Cardiovascular Events In Male Diabetics With Coronary Heart Disease
A DGReview of :"Diabetes, Plasma Insulin, and Cardiovascular Disease: Subgroup Analysis From the Department of Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT)"
Archives of Internal Medicine
12/23/2002
By James Adams
Gemfibrozil reduces major cardiovascular events in diabetic men who have both coronary heart disease and a low high-density lipoprotein cholesterol level.
It is also effective in non-diabetics who have a high fasting plasma insulin level, according to investigators from multiple American institutions involved in the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT).
The VA-HIT included 2,531 men with coronary heart disease and a high-density lipoprotein cholesterol level of 40 milligrams/decilitre or less, and a low-density lipoprotein cholesterol level of 140 milligrams/decilitre or less. The men received either gemfibrozil or placebo and were followed for an average of 5.1 years.
Subgroup analyses were performed to evaluate the effects of gemfibrozil in subjects with varying degrees of glucose tolerance or hyperinsulinemia. Associations among diabetes status, glucose levels, insulin levels and risk of cardiovascular outcomes were also assessed.
Results showed that subjects with diabetes had an increased risk of cardiovascular events compared with subjects who had normal fasting glucose levels. Persons without diabetes but with fasting plasma glucose of 39 microunits/millilitre or higher also showed increased risk.
Gemfibrozil reduced risk of cardiovascular events by 32 percent in persons with diabetes. Risk of death caused by coronary heart disease was reduced by 41 percent. Risk was reduced by 35 percent in non-diabetic subjects whose fasting plasma insulin level fell into the highest quartile.
The VA-HIT was funded by the Cooperative Studies Program of the Department of Veterans Affairs, Office of Research and Development in Washington, D.C and by a supplemental grant from Parke-Davis, a division of Warner-Lambert.
Arch Intern Med 2002; 162: 2597-2604.
"Diabetes, Plasma Insulin, and Cardiovascular Disease: Subgroup Analysis From the Department of Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT)"
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