VA-HIT Trial

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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To determine if the reduction in major CHD events (MI and CHD deaths) with gemfibrozil could be attributed to changes in major plasma lipid levels.

VA-HIT (Veterans Affairs HDL Intervention Trial) trial is a multicentered, randomized, double-blinded, placebo-controlled trial wherein 2531 patients with CAD along with LDL levels ≤140 mg/dL (mean 111 mg/dL) and HDL ≤40 mg/dL (mean 32 mg/dL) were randomly assigned to treatment with gemfibrozil (1200mg) or placebo. The median follow-up was 5.1 years.

• Mean HDL-C level was higher by 6% in the group treated with gemfibrozil.
• Mean TG concentration was lower by 31% in the group treated with gemfibrozil.
• Mean total cholesterol was 4% lower in the group treated with gemfibrozil.

• The combined primary end point of cardiac death and non-fatal myocardial infarction occurred in 17.3% versus 21.7% in the group receiving gemfibrozil and the placebo group respectively.
• There was a risk reduction of 22% in the primary outcome (p=.0006) and 24% risk reduction in the combined endpoint of stroke, MI, and CHD death
• Acute coronary events were reduced by 11% with gemfibrozil for every 5 mg/dL rise in HDL-C, but the reduction was independent of changes in LDL-C and triglyceride levels.

Low HDL-C levels strongly and independently predict the occurrence of coronary events. Gemfibrozil reduced the rate of coronary events by raising HDL-C and lowering triglycerides without lowering LDL-C.^{[1][2][3][4][5]}