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)

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...