L'etude clinique du mois. Interet d'augmenter un taux de cholesterol HDL bas en prevention secondaire de la coronaropathie: resultats de l'etude VA-HIT.

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary prevention of coronary heart disease. It demonstrates that a fibrate treatment (gemfibrozil) significantly reduces the relative risk of major coronary (-22%, p = 0.006) and cardiovascular (-24%, p < 0.001) events in men with coronary heart disease whose primary lipid abnormality is a low HDL cholesterol level. These findings suggest that, in such a population, the rate of coronary events is reduced under gemfibrozil therapy by raising HDL cholesterol levels (+6%) and lowering levels of triglycerides (-31%) without lowering LDL cholesterol concentrations.