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Biomedical subjects

H Buchwald

Publications and source records attributed to H Buchwald.

At least 37 records · Page 2Linked to original sources
PubMed1996

Impact of cholesterol reduction on peripheral arterial disease in the Program on the Surgical Control of the Hyperlipidemias (POSCH).

BACKGROUND: Few lipid/atherosclerosis intervention trials have assessed the impact of cholesterol reduction on peripheral arterial disease. The 838 patients evaluated in the Program on the Surgical Control of the Hyperlipidemias (POSCH) trial represent more than the total number of patients in the seven previously reported studies. METHODS: Peripheral arterial disease in POSCH was assessed by progression of clinical disease, serial changes in the systolic blood pressure ankle/brachial index (ABI), and changes on sequential peripheral arteriograms. RESULTS: At the time of formal closure of the POSCH trial on July 19, 1990, claudication or limb-threatening ischemia was exhibited in 72 of 417 control group (CG) patients and in 54 of 421 intervention group (IG) patients (IG relative risk [RR] 0.702, 95% confidence interval [CI] 0.169 to 1.000, p = 0.049). With additional follow-up evaluation to September 30, 1994, clinical peripheral arterial disease was evident in 91 CG patients and 64 IG patients (RR 0.656, 95% CI 0.200 to 0.903, p = 0.009). At the 5-year follow-up evaluation, an ABI of less than 0.95 was present in 41 of 120 CG patients and in 24 of 126 IG patients, all of whom had an ABI of 0.95 or greater at baseline (RR in the IG of 0.557, 95% CI 0.360 to 0.863, p < 0.01). No appreciable differences were noted in the progression or regression of arteriographic peripheral arterial disease between the two groups. CONCLUSIONS: Effective cholesterol reduction in POSCH led to statistically significant differences between the control and the intervention groups in the development of clinically evident peripheral arterial disease and in the ABI values, but not in the peripheral arteriograms. Additional studies need to assess the correlation between peripheral arterial changes and coronary arterial changes and clinical atherosclerosis events. Intervention trials that study peripheral arterial disease have intrinsic value in the evaluation of the impact of risk factor modification on progression of atherosclerotic peripheral arterial disease.

Angiography↗
PubMed1996

Gender-based mortality follow-up from the Program on the Surgical Control of the Hyperlipidemias (POSCH) and meta-analysis of lipid intervention trials. Women in POSCH and other lipid trials.

OBJECTIVE: The authors assessed the clinical results of lipid-lowering therapy in women. SUMMARY BACKGROUND DATA: The Program on the Surgical Control of the Hyperlipidemias (POSCH) has demonstrated that effective lowering of total cholesterol and low-density lipoprotein cholesterol in a postmyocardial infarction population significantly reduces atherosclerotic coronary heart disease (ACHD) mortality, ACHD mortality combined with a new confirmed nonfatal myocardial infarction, and the number of coronary artery bypass grafting and angioplasty procedures performed. METHODS: A review and meta-analysis were performed of the seven primary or secondary lipid/ atherosclerosis intervention trials-including POSCH-published in the English-language literature that included women and published results in women separate from the results in men or in the entire trial population. The main outcome measure analyzed was overall mortality. RESULTS: The Scottish Physicians Clofibrate Study, the Newcastle upon Tyne Clofibrate Study, and the Pravastatin Limitation of Atherosclerosis in the Coronary Arteries (PLAC I) Trial may have demonstrated a possible benefit in ACHD prognosis from effective lipid intervention in women. The other four available trials did not. The Minnesota Coronary Survey reported a 15.6% increase in overall mortality rate and a 30.6% increase in a combined cardiovascular endpoint rate in the lipid-intervention group. The Upjohn Colestipol Study demonstrated statistically significant reductions in overall and ACHD mortality in the men, but not in the women. The Scandinavian.

Cholesterol↗
PubMed1995

Effect of lovastatin alone and as an adjuvant chemotherapeutic agent on hepatoma tissue culture-4 cell growth.

BACKGROUND: Cholesterol is essential for cell viability and growth. Interference with the cholesterol biosynthetic pathway with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (e.g., lovastatin) may preferentially slow malignant cell growth and offer a new approach to cancer chemotherapy. To test this hypothesis, we evaluated the effect of lovastatin alone, and as an adjuvant chemotherapeutic agent, on the growth and function of hepatoma tissue culture-4 (HTC-4) cells. METHODS: HTC-4 cells were treated with lovastatin at concentrations of 1, 3, 5, and 10 microM, with mitomycin-C at concentrations of 10, 25, 50, and 100 nM, or with combinations of the two drugs. Cell growth was evaluated by daily cell counts and substrate adhesion to fibronectin. RESULTS: Lovastatin alone slowed HTC-4 cell growth at concentrations as low as 1 microM (p < 0.01). Mitomycin-C alone slowed HTC-4 cell growth at concentrations of 25 nM and above (p < 0.01). Lovastatin added to mitomycin-C-treated cells resulted in a significant adjuvant effect, with cell growth slowed by an additional 20-30% by 1 microM lovastatin and by an additional 43-63% by 5 microM lovastatin, compared to mitomycin-C alone (p < 0.01). Lovastatin-treated cells also exhibited decreased adherence to substrate (p < 0.05). CONCLUSIONS: Lovastatin is effective alone and as an adjuvant to mitomycin-C in slowing the growth of HTC-4 cells. These in vitro results support further investigation of lovastatin as an adjuvant chemotherapeutic agent in animal models.

Animals↗
PubMed1995

Effect of aspirin use on death and recurrent myocardial infarction in current and former cigarette smokers. Program on the Surgical Control of the Hyperlipidemias Group.

The purpose of this study was to examine the effects of aspirin use on mortality and morbidity rates in a subset of the control group of the Program on the Surgical Control of the Hyperlipidemias (POSCH) that was stratified by cigarette smoking status at the time of randomization. The clinical impact of aspirin intake in cigarette smokers and former cigarette smokers has not been well studied. POSCH was a randomized, controlled, clinical trial designed to ascertain the effects of lipid modification by the partial ileal bypass operation on clinical end-points and arteriographic changes in postmyocardial infarction subjects with hypercholesterolemia. Cohorts of cigarette smokers in the diet-control group were evaluated for overall and atherosclerotic coronary heart disease (ACHD) mortality rates and recurrent confirmed nonfatal myocardial infarction rates. In current cigarette smokers at baseline (n = 90) with a mean follow-up of 8.3 years, the overall mortality rate was 45.2% in patients with no aspirin use and 10.4% in patients who reported even infrequent aspirin use (relative risk = 4.3, 95% confidence interval (CI) = 2.4 to 10.6, p < 0.001). For ACHD mortality in this cohort, the relative risk was 17.1 (35.7% vs 2.1%, 95% CI = 1.4 to 125.0, p < 0.001); for the combined end-point of ACHD mortality and nonfatal myocardial infarction, the relative risk was 2.4 (40.5% vs 16.7%, 95% CI = 1.2 to 5.1, p = 0.018).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspirin↗
PubMed1995

Disease-free intervals after partial ileal bypass in patients with coronary heart disease and hypercholesterolemia: report from the Program on the Surgical Control of the Hyperlipidemias (POSCH).

OBJECTIVES: We sought to analyze the disease-free intervals and calculate the freedom from atherosclerosis events in the Program on the Surgical Control of the Hyperlipidemias (POSCH). BACKGROUND: The POSCH study was a randomized, secondary lipid/atherosclerosis intervention trial that provided strong evidence for reduction in atherosclerosis progression as demonstrated by clinical and arteriographic end points. The 417 control group patients received American Heart Association phase II diet instruction, and the 421 intervention group patients received identical dietary instruction and underwent a partial ileal bypass operation. METHODS: Four outcome measures were determined: 1) overall mortality, 2) coronary heart disease mortality, 3) coronary heart disease mortality and confirmed nonfatal myocardial infarction, and 4) coronary/cardiac interventions. RESULTS: An overall mortality rate of 10% occurred at 6.7 years in the control group and 9.4 years in the intervention group, for a gain in disease-free interval of 2.7 years in the intervention group (p = 0.032). A coronary heart disease mortality rate of 8% occurred at 7.2 years in the control group and 11 years in the intervention group, for a gain of 3.8 years (p = 0.046). Twenty percent of patients demonstrated the combined end point of coronary heart disease mortality and confirmed nonfatal myocardial infarction at 5.9 years in the control group and 11.4 years in the intervention group, for a gain of 5.5 years (p < 0.001). Twenty-five percent of patients underwent either coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty or heart transplantation at 5.4 years in the control group and 12.4 years in the intervention group, for a gain of 7 years (p < 0.001). CONCLUSIONS: The marked lipid modification achieved by partial ileal bypass in the POSCH trial led to demonstrable increases in the disease-free intervals for overall mortality, coronary heart disease mortality, coronary heart disease mortality and confirmed nonfatal myocardial infarction, and coronary intervention procedures. For the clinician and the patient, estimation of disease-free intervals may be more relevant than assessment of differences in incidence rates and risk ratios.

Adult↗
PubMed1995

Subgroup analyses of the major clinical endpoints in the Program on the Surgical Control of the Hyperlipidemias (POSCH): overall mortality, atherosclerotic coronary heart disease (ACHD) mortality, and ACHD mortality or myocardial infarction.

The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a secondary atherosclerosis intervention trial employing partial ileal bypass surgery as the intervention modality. For this report, we analyzed 105 subgroups in 35 variables in POSCH, chosen predominantly for their potential relationship to the risk of atherosclerotic coronary heart disease (ACHD). We defined potential differential effects as those with: (1) an absolute z-value > or = 2.0 for the subgroup, if the absolute z-value for the overall effect was < 2.0; and (2) an absolute z-value > or = 3.0 for the subgroup and a relative risk < or = 0.5, if the absolute z-value for the overall effect was > or = 2.0. For each of three major POSCH endpoints of overall mortality, ACHD mortality and ACHD mortality or confirmed nonfatal myocardial infarction, we found seven subgroups with a differential risk reduction in the surgery group as compared to the control group. Allowing for identical subgroups for more than one endpoint, there were 13 individual subgroups with differential effects. Of these, seven demonstrated internal consistency across endpoints, and five of these seven displaced external consistency with known ACHD risk factors and for biological plausibility: triglyceride concentration > or = 200 mg/dl; cigarette smoking; overt or borderline diabetes mellitus; a Minnesota ECG Q-QS code of 1-1; and obesity. A greater risk reduction, in comparison to the overall treatment effect, by the reduction of a single risk factor, hypercholesterolemia, in patients with at least two major ACHD risk factors was a provocative and an hypothesis-generating outcome of this analysis. The clinical implications of this finding may lead to more aggressive cholesterol intervention in patients with multiple ACHD risk factors.

Adult↗
PubMed1995

Program on the surgical control of the hyperlipidemias: 1994 report.

The Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized clinical trial, tested the hypothesis that cholesterol modification induced by partial ileal bypass would favorably affect mortality and morbidity due to coronary heart disease (CHD). The study population consisted of 838 patients (417 in the control group and 421 in the surgery group) in four clinical centers, both men (90.7%) and women with an average age of 51 years who had survived a first myocardial infarction. The lipid changes in POSCH have been the most marked in any atherosclerosis intervention trial utilizing a single mode of intervention in addition to diet therapy. At 5 years, the surgery group, compared with the control group, had a 23.3 +/- 1.0% (mean +/- SE) lower total plasma cholesterol level (p < 0.0001), a 37.7 +/- 1.2% lower low-density lipoprotein cholesterol level (p < 0.0001), and a 4.3 +/- 1.8% higher high-density lipoprotein cholesterol level (p = 0.02). For the combined end point of CHD mortality and confirmed nonfatal myocardial infarction, there was a 35.0% reduction in the surgery group (p < 0.001). Coronary artery bypass grafting was reduced in the surgery group by 62.0% (p < 0.0001) and percutaneous transluminal coronary angioplasty was reduced by 55.0% (p < 0.01). A comparison of baseline coronary arteriograms with those obtained at 3, 5, 7, and 10 years consistently showed less atherosclerosis disease progression (p < 0.001) and greater atherosclerosis disease regression at 5 and 7 years (p < 0.01) in the surgery group. At formal trial completion in July 1990, the overall mortality in the surgery subgroup with an ejection fraction of 50% or greater was 36.1% lower (p = 0.02). During subsequent follow-up, trends toward statistical significance for differences in both CHD and in overall mortality have become evident. The POSCH results provide strong support for beneficial clinical and arteriographic reduction of atherosclerosis progression after lipid modification by partial ileal bypass.

Adult↗
PubMed1994

Improvement in Obesity-associated Medical Conditions following Vertical Banded Gastroplasty and Gastrointestinal Bypass.

Thirty-nine patients undergoing either Silastictrade mark ring vertical banded gastroplasty (SRVG, n = 23) or Roux-en-Y gastrointestinal bypass (RGB, n = 16) over a 1-year period were analyzed retrospectively. Weight loss averaged 40 kg (89 lb). Clinical diabetes mellitus was markedly improved in seven out of nine patients (p = 0.023). Shortness of breath resolved in all 26 patients who had this condition preoperatively (p < 0.001). Orthopedic problems, high blood pressure, and self-assessment of general health and quality of life were also dramatically improved. We conclude that bariatric surgery serves as an effective method to alleviate a multitude of conditions associated with morbid obesity.

Journal Article↗
PubMed1993

Reduction of atherosclerosis with nonsteroidal anti-inflammatory drugs.

The cellular mechanisms involved in the pathogenesis of atherosclerosis may be similar to the events in the inflammatory response. Many of these processes are activated by the arachidonic acid cascade. The nonsteroidal anti-inflammatory drugs inhibit the cycloxegenase and possibly the lipoxegenase pathways, decreasing the production of prostaglandins, thromboxanes, and leukotrienes, all components of the inflammatory process. We have inhibited the arachidonic acid cascade with the nonsteroidal anti-inflammatory drugs, indomethacin (5 mg/kg/day) and phenylbutazone (10mg/kg/day). Forty-five New Zealand white rabbits were given a 0.25% cholesterol diet for 16 weeks in addition to the drugs or a placebo. Serial plasma lipid profiles were performed; aortic and peripheral arterial cholesterol content measurements were obtained at sacrifice. All groups showed markedly elevated plasma lipids. Thoracic aortic and carotid artery cholesterol contents were significantly decreased in both treated groups as compared to placebo (P < 0.05), despite the atherogenic lipid profiles. These results implicate the immune and inflammatory responses in the pathogenesis of atherogenesis.

Animals↗
PubMed1993

Perception of quality of life before and after disclosure of trial results: a report from the Program on the Surgical Control of the Hyperlipidemias (POSCH).

The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a randomized controlled clinical trial designed to ascertain whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality and the mortality and morbidity due to coronary heart disease. The trial results provided strong clinical and coronary arteriographic support for the beneficial effects of lipid modification for the reduction of atherosclerosis progression. At the same time, the surgery-assigned group experienced diarrhea and an increased incidence of kidney stones and gallstones compared to the control-assigned group. Identical quality of life determinations were performed in the POSCH study population shortly before disclosure of the trial results to the patients and shortly thereafter. The purpose of this dual assessment was to evaluate the effect of knowledge of outcomes on the patients' subjective evaluation of quality of life. The primary instrument utilized for analysis of the perception of quality of life in POSCH was the McMasters Health Index Questionnaire (MHIQ). In addition, four study-specific questions were asked of the trial patients. The results for the MHIQ before disclosure of trial results showed a difference (p = 0.07) favoring the control-assigned group (diet-treated), for the social function index of the MHIQ. After disclosure of the trial results, the difference was larger (p < 0.05). For the four study-specific questions, all differences favored the control-assigned group (p < 0.01) before and after disclosure of the trial results, with the exception of satisfaction with randomization allocation in the surgery-assigned group (p = 0.08). The intragroup MHIQ indices before and after disclosure of the trial results showed no suggestive significant differences, except in the surgery-assigned group, in which there was an improvement in the emotional function index after disclosure of the trial results (p = 0.03). The intragroup responses to the study-specific questions before and after disclosure of the trial results again showed no significant differences, except in the surgery-assigned group, in which there was an improvement in patient satisfaction with randomization allocation after disclosure of the trial results (p = 0.04).(ABSTRACT TRUNCATED AT 400 WORDS)

Attitude to Health↗
PubMed1993

Natural history of atherosclerosis and hyperlipidemia in heterozygous WHHL (WHHL-Hh) rabbits. II. Morphologic evaluation of spontaneously occurring aortic and coronary lesions.

This study evaluated the morphologic appearance of spontaneous aortic and coronary atherosclerotic lesions in 21 of the 28, 3-year old, heterozygous Watanabe heritable hyperlipidemic (WHHL-Hh) rabbits whose lipid profiles were presented in part I of this report. In situ perfusion fixation of the arteries showed 100% of the aortas involved with one or another type of intimal lesion. In male rabbits (n = 13), the abdominal aortas had more severe fibrosis and more diffuse intima thickening than the thoracic aortas, (p < 0.001). In female rabbits (n = 8), fatty streaks and fibrous lesions were more predominant in the thoracic than in the abdominal aorta (p < 0.05). Fatty aortic plaques in the female were more commonly found in the abdominal than in the thoracic aorta, but this finding was not statistically significant. In contrast, fatty aortic plaques were not found in the male aortas; however, larger areas of diffuse intimal thickening with fatty deposits were more common in the abdominal aortas of the males (p < 0.01). Annular arteriosclerotic lesions, exclusive to the thoracic aorta, occurred in three of 21 rabbits. Histologically, the aortas demonstrated subintimal fibrosis, fragmentation of the lamina elastica interna, focal medial degeneration, and cholesterol clefts. The coronary arteries were involved in 85% of the males and in 86% of the females. Lesions were more common in the left than in the right coronary artery and primarily consisted of mild nonobstructing intimal hyperplasia with fibrosis. Based on these observations, we consider older WHHL-Hh rabbits excellent models for studying atherosclerosis. Because of their genetic and age-related lesions, WHHL-Hh rabbits may be superior to the cholesterol-fed rabbit model with respect to comparability with human atherosclerotic lesions.

Animals↗
PubMed1993

Natural history of atherosclerosis and hyperlipidemia in heterozygous WHHL (WHHL-Hh) rabbits. I. The effects of aging and gender on plasma lipids and lipoproteins.

Plasma lipid and lipoprotein levels are influenced by physiologic changes during the life span of mammalian organisms. In the present study, the effects of aging and gender on plasma lipids and lipoprotein cholesterol fractions in heterozygous Watanabe heritable hyperlipidemic (WHHL-Hh) rabbits were examined. For 3 years the rabbits were fed regular rabbit chow and were free from any experimental manipulation. Male WHHL-Hh rabbits (n = 17) had a 55% increase in total plasma cholesterol level (p < 0.005) between the ages of 7.5 and 34 months. This increase was due to significant increases in very low-density lipoprotein cholesterol (VLDL-C) (28%, p < 0.05), in low-density lipoprotein cholesterol (126%, p < 0.005), and in high-density lipoprotein cholesterol (28%, p < 0.05). Female WHHL-Hh rabbits (n = 11) did not show significant differences in lipid plasma values with aging. However, their plasma values, with the exception of the VLDL-C, were significantly (p < 0.05) higher than those of the male rabbits. Pregnancy and increased weight in the older female rabbits may have accounted for these differences. Significant plasma lipid changes occur as a function of heterozygosity, age, and gender in WHHL-Hh rabbits. The lipoprotein changes seen in male but not in female WHHL-Hh rabbits during the aging process are similar to those observed in human subjects. Pregnancy in WHHL-Hh rabbits, like in human beings, may induce hyperlipidemia, which is opposite to the effects observed in normal rabbits or homozygous WHHL rabbits.

Aging↗
PubMed1993

Serum creatinine as an independent predictor of coronary heart disease mortality in normotensive survivors of myocardial infarction. POSCH Group.

BACKGROUND: Serum creatinine has been reported in previous studies to be a prognostic indicator for overall mortality, in particular in a hypertensive population. METHODS: The Program on the Surgical Control of the Hyperlipidemias (POSCH) was a randomized, controlled clinical trial. All patients had survived a single myocardial infarction, were normotensive, were not obese, were not having heart failure, and were free of diabetes mellitus and renal disease at entry into the study. POSCH had followed its control group patients (N = 417) for a minimum of 7.0 years. In this group, a prospective post hoc analysis of the relationship of baseline serum creatinine with subsequent overall and atherosclerotic coronary heart disease mortality was performed. RESULTS: The baseline serum creatinine values in the control group patients ranged from 0.7 to 1.9 mg/dL (60 to 170 mumol/L), and were found to be independent predictors (P < .01) of both overall mortality and atherosclerotic coronary heart disease mortality. Each 0.1 mg/dL (9 mumol/L) increment in the baseline serum creatinine increased the relative risk for subsequent overall mortality by 36% and the relative risk for subsequent atherosclerotic coronary heart disease mortality by 47%. CONCLUSIONS: These results demonstrate that a serum creatinine value, obtained in normotensive, nonobese, normoglycemic survivors of a myocardial infarction without preexistent renal disease or heart failure, provides independent prognostic information regarding subsequent overall and atherosclerotic coronary heart disease mortality.

Adult↗
PubMed1992

Changes in sequential coronary arteriograms and subsequent coronary events. Surgical Control of the Hyperlipidemias (POSCH) Group.

OBJECTIVE: Assessment of the relationship between changes in sequential coronary arteriograms and subsequent clinical coronary events. DESIGN: The Program on the Surgical Control of the Hyperlipidemias, a randomized secondary atherosclerosis intervention trial, obtained coronary arteriograms at baseline, 3, 5, and 7 or 10 years of follow-up. Assessments of changes between pairs of coronary arteriograms were made by two-member panels blinded to the patients' assigned treatment and to the temporal sequence of the films. The relationship of changes between the baseline and the 3-year follow-up arteriograms and subsequent clinical coronary events was examined. SETTING: Three university hospitals and one private primary care facility. PATIENTS: A total of 838 patients, with 417 patients randomized to the control group and 421 to the intervention group. Of all patients, 695 had baseline and 3-year arteriograms. INTERVENTION: The control group received American Heart Association Phase II diet instruction and the intervention group received identical dietary instruction plus a partial ileal bypass operation. MAIN OUTCOME MEASURE: The use of arteriographic changes as a predictor of subsequent clinical coronary events. RESULTS: Changes between the baseline and the 3-year coronary arteriographic overall disease assessment were significantly associated with subsequent overall and atherosclerotic coronary heart disease mortality (P less than .01). For the combined end point of atherosclerotic coronary heart disease mortality or confirmed nonfatal myocardial infarction, a significant relationship between the overall disease assessment and subsequent clinical events was found in the control group (P less than .0001) and in the surgery group (P = .04). For this combined end point, however, the control and the surgery groups were different with respect to clinical coronary events after 3 years, stratified by the baseline to 3-year overall disease assessment (P less than .001, unadjusted; P = .06, adjusted for 3-year clinical covariates). CONCLUSIONS: Coronary arteriographic changes can be used in atherosclerosis intervention trials as a limited surrogate end point for certain clinical coronary events. This relationship is statistically compelling for overall mortality and atherosclerotic coronary heart disease mortality. For an individual patient, changes in the severity of coronary atherosclerosis seen on sequential coronary arteriograms can serve as prognostic indicators for subsequent overall or atherosclerotic coronary heart disease mortality.

Adult↗
PubMed1992

Cholesterol inhibition, cancer, and chemotherapy.

An important feature of malignant transformation is loss of the cholesterol feedback inhibition mechanism that regulates cholesterol synthesis. Cancer cells seem to require an increase in the concentrations of cholesterol and of cholesterol precursors. Therefore, a reasonable assumption is that prevention of tumour-cell growth can be achieved by restricting either cholesterol availability or cholesterol synthesis. In-vivo and cell-culture experiments have shown that lowering the plasma cholesterol concentration or intervening in the mevalonate pathway with 3-hydroxy-3-methylglutaryl (HMG) CoA reductase inhibitors decreases tumour growth. Currently prescribed doses of HMG-CoA reductase inhibitors given orally or continuously by an implantable infusion pump could achieve tumour therapeutic tissue concentrations of these agents. My hypothesis is that cholesterol inhibition can inhibit tumour cell growth, can act as an adjuvant to cancer chemotherapy, and, possibly, can prevent carcinogenesis.

Adjuvants, Pharmaceutic↗
PubMed1992

Women in the POSCH trial. Effects of aggressive cholesterol modification in women with coronary heart disease. The POSCH Group. Program on the Surgical Control of the Hyperlipidemias.

The Program on the Surgical Control of the Hyperlipidemias (POSCH) provided the clearest and the most convincing evidence supporting the beneficial effects of cholesterol lowering in hypercholesterolemic survivors of a myocardial infarction. In POSCH, 78 of the 838 patients (9.3%) were women, with 32 randomized to the diet-control group and 46 to the diet plus partial ileal bypass surgery-intervention group. At 5 years, the mean per cent change from baseline was -23.9% for total plasma cholesterol (p < 0.0001), -36.1% for low-density lipoprotein cholesterol (p < 0.0001), and +8.5% for high-density lipoprotein cholesterol (p = not significant). Because of the small number of women, no statistically significant changes in clinical event rates were observed between the control and the surgery groups. A comparison of 162 coronary arteriography film pairs in the POSCH women, between baseline and 3, 5, 7, and 10 years, consistently showed less disease progression in the surgery group (p = 0.013 for combined assessments of the baseline to the longest follow-up film). Because the lipid and coronary arteriography findings in the POSCH women paralleled these findings in the total POSCH population and in the POSCH men, and because the arteriography changes in POSCH have previously been demonstrated to be statistically significant surrogate end points for certain clinical events and predictors of overall and atherosclerotic coronary heart disease mortality rates, we conclude that the lipid modification achieved in the POSCH women by partial ileal bypass reduced their atherosclerosis progression. The POSCH findings in women support the aggressive treatment of hyperlipidemia in the general management of atherosclerosis in women.

Coronary Angiography↗