The Treatment of Cerebrovascular Disease With Clofibrate

Abstract

A cooperative study in 20 Veterans Administration hospitals investigated the effect of clofibrate on morbidity and mortality due to atherosclerotic vascular disease in men with either an established cerebral infarction or transient cerebrovascular ischemic attacks (TIA). Follow-up observations were made for up to 4.5 years in 532 patients assigned on a random basis to placebo medication or to treatment with 2 gm of clofibrate daily. Baseline and follow-up cholesterol and triglyceride levels were measured. Recurrence of cerebral infarction was increased in patients receiving clofibrate as compared to controls. The incidence of new myocardial infarction and new TIA was similar in both groups. Despite the more frequent strokes in treated patients, they had a decrease in mortality, partially explained by a lower death rate from these recurrences. There was no correlation between pretreatment lipid (cholesterol and triglyceride) values and the result of therapy. Use of clofibrate, however, was associated with a slight reduction of cholesterol and a sustained fall in triglyceride. These findings do not support recently published reports that clofibrate reduces the occurrence of myocardial ischemia; however, the investigative design and type of data collected in these various studies are different and make it difficult to compare results.