Abstract
Purpose
To determine the effects of aggressive lipid lowering on markers of ischemia, resistance
vessel function, atherosclerotic burden, and symptom status in patients with symptomatic
coronary artery disease.
Methods
Sixty consecutive patients with coronary artery disease that was unsuitable for revascularization
were assigned randomly to either usual therapy of lipids for patients with a low-density
lipoprotein (LDL) cholesterol target level <116 mg/dL, or to a more aggressive lipid-lowering
strategy involving up to 80 mg/d of atorvastatin, with a target LDL cholesterol level
<77 mg/dL. The extent and severity of inducible ischemia (by dobutamine echocardiography),
vascular function (brachial artery reactivity), atheroma burden (carotid intima-media
thickness), and symptom status were evaluated blindly at baseline and after 12 weeks
of treatment.
Results
After 12 weeks of treatment, patients in the aggressive therapy group had a significantly
greater decrease in mean (± SD) LDL cholesterol level than those in the usual care
group (29 ± 38 mg/dL vs. 7 ± 24 mg/dL, P = 0.03). Patients in the aggressive therapy group had a reduction in the number of
ischemic wall segments (mean between-group difference of 1.3; 95% confidence interval:
0.1 to 2.0; P = 0.04), flow-mediated dilatation (mean between-group difference of 5.9%; 95% confidence
interval: 2.5% to 9.4%; P = 0.001), and angina score after 12 weeks. There were no significant changes in atherosclerotic
burden in either group.
Conclusion
Patients with symptomatic coronary artery disease who are treated with aggressive
lipid lowering have improvement of symptom status and ischemia that appears to reflect
improved vascular function but not atheroma burden.
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Article info
Publication history
Accepted:
August 22,
2002
Received:
October 31,
2001
Footnotes
☆Supported in part by a grant in aid (00B-0558) from the National Heart Foundation of Australia.
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
