The National Heart, Lung and Blood Institute Type II Coronary Intervention Study, a double-blind, placebo-controlled trial, evaluated the efficacy of reduction in cholesterol levels induced by cholestyramine on progression of coronary artery disease (CAD). The rate of CAD progression in patients treated with cholestyramine plus diet was compared with that of patients treated with placebo plus diet. CAD progression was defined angiographically. Significant decrease in total cholesterol (TC) and low-density lipoprotein cholesterol (LDLC) and increases in high-density lipoprotein cholesterol (HDLL). as well as in HDLC/TC and HDLC/LDLC ratios, were observed with cholestyramine. HDLC change was due to increase in HDL2A and HDL2B. When the relationship between CAD progression and lipid changes was examined independent of specific treatment group, a significant inverse relationship was found between progression at 5 years and the combination of an increase in HDLC and a decrease in LDL,; changes in HDLC/TC and HDLC/LDLc were the best predictors of CAD change. While the testing of these relationships independent of treatment group was not part of the initial study design, the trends were observed in both the placebo-treated and cholestyramine-treated groups. Moreover, with multivariate analysis, the effect of cholestyramine treatment on CAD progression was eliminated by adding changes in HDLC/TC to the regression model. These findings support the hypothesis that increases in HDLC and decreases in TC (or LDLC) can prevent or delay CAD progression. Circulation 69, No. 2, 325-337, 1984 medication was prescribed, and patients were followed at monthly clinical visits over a period of 5 years. In previous articles the design and baseline findings,' the method of assessing angiographic progression of disease, and the primary end point results were reported.2 The major purpose of this report is to describe both the lipid response to treatment and the relationship between this lipid response and CAD progression. The relationship between baseline lipid levels and other characteristics, as well as the lipid response to treatment, is also explored.
MethodsThe specific criteria for this study stipulated that only those subjects with elevated levels of LDLC were eligible. Serial sampling before and after a low-cholesterol, low-fat diet effectively screened out those subjects with LDLC elevations secondary to diet.' Criteria for lipid screening used in the trial are presented in table 1. Compliance to taking medication was estimated at