BACKGROUND: It is unclear whether a marked reduction of low-density lipoprotein-cholesterol (LDL-C) in patients with coronary heart disease (CHD) and mild hypercholesterolemia leads to less progression of atherosclerosis. METHODS AND RESULTS: Patients with CHD and hypercholesterolemia (100<LDL-C<140 mg/dl) who underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) were randomly assigned to the atorvastatin (10-20 mg/day) group or ;usual care' group. After 12 months 58 patients had follow-up CAG and IVUS studies that could be evaluated. Cross-sectional areas of the vessel, lumen, and plaque were measured at 1-mm intervals, and volumetric calculations were based on Simpson's rule. After 12 months, the mean reduction of LDL-C was 34% in the atorvastatin group and 0% in the usual care group (p<0.01). The mean absolute plaque volume showed a larger increase in the usual care group than in the atorvastatin group (atorvastatin -1.4+/-11.6 mm3, usual care 7.6+/-10.3 mm3; p<0.01). Vessel volume also showed a larger increase in the usual care group than in the atorvastatin group (atorvastatin 2.2+/-10.9 mm3, usual care 10.9+/-17.7 mm3; p=0.03). CONCLUSIONS:Atorvastatin treatment prevented the further progression of atherosclerosis by maintaining LDL-C below 100 mg/dl in patients with CHD and hypercholesterolemia (100<LDL-C<140 mg/dl).
RCT Entities:
BACKGROUND: It is unclear whether a marked reduction of low-density lipoprotein-cholesterol (LDL-C) in patients with coronary heart disease (CHD) and mild hypercholesterolemia leads to less progression of atherosclerosis. METHODS AND RESULTS:Patients with CHD and hypercholesterolemia (100<LDL-C<140 mg/dl) who underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) were randomly assigned to the atorvastatin (10-20 mg/day) group or ;usual care' group. After 12 months 58 patients had follow-up CAG and IVUS studies that could be evaluated. Cross-sectional areas of the vessel, lumen, and plaque were measured at 1-mm intervals, and volumetric calculations were based on Simpson's rule. After 12 months, the mean reduction of LDL-C was 34% in the atorvastatin group and 0% in the usual care group (p<0.01). The mean absolute plaque volume showed a larger increase in the usual care group than in the atorvastatin group (atorvastatin -1.4+/-11.6 mm3, usual care 7.6+/-10.3 mm3; p<0.01). Vessel volume also showed a larger increase in the usual care group than in the atorvastatin group (atorvastatin 2.2+/-10.9 mm3, usual care 10.9+/-17.7 mm3; p=0.03). CONCLUSIONS:Atorvastatin treatment prevented the further progression of atherosclerosis by maintaining LDL-C below 100 mg/dl in patients with CHD and hypercholesterolemia (100<LDL-C<140 mg/dl).