Sander J. Robins, MD

In a case-control substudy of the Veterans Affairs High-Density Lipoprotein Intervention Trial, therapy with gemfibrozil was shown to reduce the total number of low-density lipoprotein (LDL) particles, especially small, more oxidizable LDL particles, which was associated with a reduced risk of coronary heart disease (CHD) events. Gemfibrozil also increased small-sized high-density lipoprotein particle numbers, which also correlated with a decrease in CHD events. Notably, these changes in particle numbers were not associated with significant changes in lipoprotein cholesterol concentrations, which current guidelines have made the principal target of lipid therapy.