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
| Autor: | Richard L. Varco, Henry Buchwald, Robert D. Smink, John P. Matts, John M. Long, Henry S. Sawin, Laurie L. Fitch, Albert E. Yellin, Malcolm B. Pearce, Gilbert S. Campbell, Christian T. Campos |
|---|---|
| Rok vydání: | 1995 |
| Předmět: |
Adult
Male Risk medicine.medical_specialty Epidemiology medicine.medical_treatment Myocardial Infarction Hyperlipidemias Coronary Artery Disease law.invention Electrocardiography Jejunoileal Bypass Randomized controlled trial law Internal medicine Diabetes mellitus medicine Clinical endpoint Humans Prospective Studies Derivation Myocardial infarction Mortality Risk factor Proportional Hazards Models Anthropometry business.industry Middle Aged medicine.disease United States Surgery Cholesterol Relative risk Partial ileal bypass surgery Cardiology Female business Program Evaluation |
| Zdroj: | Journal of Clinical Epidemiology. 48:389-405 |
| ISSN: | 0895-4356 |
| DOI: | 10.1016/0895-4356(94)00145-g |
| Popis: | 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-valueor = 2.0 for the subgroup, if the absolute z-value for the overall effect was2.0; and (2) an absolute z-valueor = 3.0 for the subgroup and a relative riskor = 0.5, if the absolute z-value for the overall effect wasor = 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 concentrationor = 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect