Effect of Partial Ileal Bypass Surgery on Mortality and Morbidity from Coronary Heart Disease in Patients with Hypercholesterolemia

作者：Hēnry Buchwald, Richard L. Varco, John P. Matts, John M. Long, Laurie L. Fitch, Gilbert S. Campbell, Malcolm B. Pearce, Albert E. Yellin, W.Allan Edmiston, Robert D. Smink, Henry S. Sawin, Christian T. Campos, Betty J. Hansen, Naip Tuna, James N. Karnegis, Miguel E. Sanmarco, Kurt Amplatz, Wilfredo R. Castaneda-Zuniga, David W. Hunter, Joseph K. Bissett, Frederic J. Weber, James W. Stevenson, Arthur S. Leon, Thomas C. Chalmers · 发表于：New England Journal of Medicine · 年份：1990 · DOI：10.1056/nejm199010043231404 · 被引用次数：1008 · 研究领域：Bariatric Surgery and Outcomes、Cardiac, Anesthesia and Surgical Outcomes、Lipoproteins and Cardiovascular Health

BACKGROUND AND METHODS: The Program on the Surgical Control of the Hyperlipidemias (POSCH), a randomized clinical trial, was designed to test whether cholesterol lowering induced by the partial ileal bypass operation would favorably affect overall mortality or mortality due to coronary heart disease. The study population consisted of 838 patients (417 in the control group and 421 in the surgery group), both men (90.7 percent) and women, with an average age of 51 years, who had survived a first myocardial infarction. The mean follow-up period was 9.7 years. RESULTS: When compared with the control group at five years, the surgery group had a total plasma cholesterol level 23.3 percent lower (4.71 +/- 0.91 vs. 6.14 +/- 0.89 mmol per liter [mean +/- SD]; P less than 0.0001), a low-density lipoprotein cholesterol level 37.7 percent lower (2.68 +/- 0.78 vs. 4.30 +/- 0.89 mmol per liter; P less than 0.0001), and a high-density lipoprotein cholesterol level 4.3 percent higher (1.08 +/- 0.26 vs. 1.04 +/- 0.25 mmol per liter; P = 0.02). Overall mortality and mortality due to coronary heart disease were reduced, but not significantly so (deaths overall [control vs. surgery], 62 vs. 49, P = 0.164; deaths due to coronary disease, 44 vs. 32, P = 0.113). The overall mortality in the surgery subgroup with an ejection fraction greater than or equal to 50 percent was 36 percent lower (control vs. surgery, 39 vs. 24; P = 0.021). The value for two end points combined--death due to coronary heart...