Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with Hypercholesterolemia: Report of the program on the surgical control of the Hyperlipidemias (POSCH)

Henry 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. BissettFrederic J. Weber, James W. Stevenson, Arthur S. Leon, Thomas C. Chalmers

Research output: Contribution to journalArticle

803 Citations (Scopus)

Abstract

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<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<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 ≥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 disease and confirmed nonfatal myocardial infarction - was 35 percent lower in the surgery group (125 vs. 82 events; P<0.001). During follow-up, 137 control-group and 52 surgery-group patients underwent coronary-artery bypass grafting (P<0.0001). A comparison of base-line coronary arteriograms with those obtained at 3, 5, 7, and 10 years consistently showed less disease progression in the surgery group (P<0.001). The most common side effect of partial ileal bypass was diarrhea; others included occasional kidney stones, gallstones, and intestinal obstruction. Conclusions. Partial ileal bypass produces sustained improvement in the blood lipid patterns of patients who have had a myocardial infarction and reduces their subsequent morbidity due to coronary heart disease. The role of this procedure in the management of hypercholesterolemia remains to be determined. These results provide strong evidence supporting the beneficial effects of lipid modification in the reduction of atherosclerosis progression.

Original languageEnglish (US)
Pages (from-to)946-955
Number of pages10
JournalNew England Journal of Medicine
Volume323
Issue number14
StatePublished - Oct 4 1990
Externally publishedYes

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Hypercholesterolemia
Hyperlipidemias
Coronary Disease
Morbidity
Mortality
Myocardial Infarction
Control Groups
Cholesterol
Lipids
Kidney Calculi
Intestinal Obstruction
Gallstones
Coronary Artery Bypass
LDL Cholesterol
HDL Cholesterol
Disease Progression
Diarrhea
Atherosclerosis
Randomized Controlled Trials
Population

ASJC Scopus subject areas

  • Medicine(all)

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Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with Hypercholesterolemia : Report of the program on the surgical control of the Hyperlipidemias (POSCH). / Buchwald, Henry; Varco, Richard L.; Matts, John P.; Long, John M.; Fitch, Laurie L.; Campbell, Gilbert S.; Pearce, Malcolm B.; Yellin, Albert E.; Edmiston, W. Allan; Smink, Robert D.; Sawin, Henry S.; Campos, Christian T.; Hansen, Betty J.; Tuna, Naip; Karnegis, James N.; Sanmarco, Miguel E.; Amplatz, Kurt; Castaneda-Zuniga, Wilfredo R.; Hunter, David W.; Bissett, Joseph K.; Weber, Frederic J.; Stevenson, James W.; Leon, Arthur S.; Chalmers, Thomas C.

In: New England Journal of Medicine, Vol. 323, No. 14, 04.10.1990, p. 946-955.

Research output: Contribution to journalArticle

Buchwald, H, Varco, RL, Matts, JP, Long, JM, Fitch, LL, Campbell, GS, Pearce, MB, Yellin, AE, Edmiston, WA, Smink, RD, Sawin, HS, Campos, CT, Hansen, BJ, Tuna, N, Karnegis, JN, Sanmarco, ME, Amplatz, K, Castaneda-Zuniga, WR, Hunter, DW, Bissett, JK, Weber, FJ, Stevenson, JW, Leon, AS & Chalmers, TC 1990, 'Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with Hypercholesterolemia: Report of the program on the surgical control of the Hyperlipidemias (POSCH)', New England Journal of Medicine, vol. 323, no. 14, pp. 946-955.
Buchwald, Henry ; Varco, Richard L. ; Matts, John P. ; Long, John M. ; Fitch, Laurie L. ; Campbell, Gilbert S. ; Pearce, Malcolm B. ; Yellin, Albert E. ; Edmiston, W. Allan ; Smink, Robert D. ; Sawin, Henry S. ; Campos, Christian T. ; Hansen, Betty J. ; Tuna, Naip ; Karnegis, James N. ; Sanmarco, Miguel E. ; Amplatz, Kurt ; Castaneda-Zuniga, Wilfredo R. ; Hunter, David W. ; Bissett, Joseph K. ; Weber, Frederic J. ; Stevenson, James W. ; Leon, Arthur S. ; Chalmers, Thomas C. / Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with Hypercholesterolemia : Report of the program on the surgical control of the Hyperlipidemias (POSCH). In: New England Journal of Medicine. 1990 ; Vol. 323, No. 14. pp. 946-955.
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abstract = "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<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<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 ≥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 disease and confirmed nonfatal myocardial infarction - was 35 percent lower in the surgery group (125 vs. 82 events; P<0.001). During follow-up, 137 control-group and 52 surgery-group patients underwent coronary-artery bypass grafting (P<0.0001). A comparison of base-line coronary arteriograms with those obtained at 3, 5, 7, and 10 years consistently showed less disease progression in the surgery group (P<0.001). The most common side effect of partial ileal bypass was diarrhea; others included occasional kidney stones, gallstones, and intestinal obstruction. Conclusions. Partial ileal bypass produces sustained improvement in the blood lipid patterns of patients who have had a myocardial infarction and reduces their subsequent morbidity due to coronary heart disease. The role of this procedure in the management of hypercholesterolemia remains to be determined. These results provide strong evidence supporting the beneficial effects of lipid modification in the reduction of atherosclerosis progression.",
author = "Henry Buchwald and Varco, {Richard L.} and Matts, {John P.} and Long, {John M.} and Fitch, {Laurie L.} and Campbell, {Gilbert S.} and Pearce, {Malcolm B.} and Yellin, {Albert E.} and Edmiston, {W. Allan} and Smink, {Robert D.} and Sawin, {Henry S.} and Campos, {Christian T.} and Hansen, {Betty J.} and Naip Tuna and Karnegis, {James N.} and Sanmarco, {Miguel E.} and Kurt Amplatz and Castaneda-Zuniga, {Wilfredo R.} and Hunter, {David W.} and Bissett, {Joseph K.} and Weber, {Frederic J.} and Stevenson, {James W.} and Leon, {Arthur S.} and Chalmers, {Thomas C.}",
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TY - JOUR

T1 - Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with Hypercholesterolemia

T2 - Report of the program on the surgical control of the Hyperlipidemias (POSCH)

AU - Buchwald, Henry

AU - Varco, Richard L.

AU - Matts, John P.

AU - Long, John M.

AU - Fitch, Laurie L.

AU - Campbell, Gilbert S.

AU - Pearce, Malcolm B.

AU - Yellin, Albert E.

AU - Edmiston, W. Allan

AU - Smink, Robert D.

AU - Sawin, Henry S.

AU - Campos, Christian T.

AU - Hansen, Betty J.

AU - Tuna, Naip

AU - Karnegis, James N.

AU - Sanmarco, Miguel E.

AU - Amplatz, Kurt

AU - Castaneda-Zuniga, Wilfredo R.

AU - Hunter, David W.

AU - Bissett, Joseph K.

AU - Weber, Frederic J.

AU - Stevenson, James W.

AU - Leon, Arthur S.

AU - Chalmers, Thomas C.

PY - 1990/10/4

Y1 - 1990/10/4

N2 - 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<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<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 ≥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 disease and confirmed nonfatal myocardial infarction - was 35 percent lower in the surgery group (125 vs. 82 events; P<0.001). During follow-up, 137 control-group and 52 surgery-group patients underwent coronary-artery bypass grafting (P<0.0001). A comparison of base-line coronary arteriograms with those obtained at 3, 5, 7, and 10 years consistently showed less disease progression in the surgery group (P<0.001). The most common side effect of partial ileal bypass was diarrhea; others included occasional kidney stones, gallstones, and intestinal obstruction. Conclusions. Partial ileal bypass produces sustained improvement in the blood lipid patterns of patients who have had a myocardial infarction and reduces their subsequent morbidity due to coronary heart disease. The role of this procedure in the management of hypercholesterolemia remains to be determined. These results provide strong evidence supporting the beneficial effects of lipid modification in the reduction of atherosclerosis progression.

AB - 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<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<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 ≥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 disease and confirmed nonfatal myocardial infarction - was 35 percent lower in the surgery group (125 vs. 82 events; P<0.001). During follow-up, 137 control-group and 52 surgery-group patients underwent coronary-artery bypass grafting (P<0.0001). A comparison of base-line coronary arteriograms with those obtained at 3, 5, 7, and 10 years consistently showed less disease progression in the surgery group (P<0.001). The most common side effect of partial ileal bypass was diarrhea; others included occasional kidney stones, gallstones, and intestinal obstruction. Conclusions. Partial ileal bypass produces sustained improvement in the blood lipid patterns of patients who have had a myocardial infarction and reduces their subsequent morbidity due to coronary heart disease. The role of this procedure in the management of hypercholesterolemia remains to be determined. These results provide strong evidence supporting the beneficial effects of lipid modification in the reduction of atherosclerosis progression.

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