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Effect on coronary atherosclerosis of decrease in plasma cholesterol concentrations in normocholesterolaemic
F M Sacks1, R C Pasternak, C M Gibson
1Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Lancet (London, England)
|October 29, 1994
Summary
Intensive lipid-lowering treatment in patients with normal cholesterol and coronary heart disease did not improve coronary atherosclerosis. Despite significant changes in lipid levels, this approach offered no measurable benefit to coronary arteries.
Area of Science:
- Cardiology
- Pharmacology
- Atherosclerosis Research
Background:
- Lipid-lowering therapy is known to benefit patients with high low-density-lipoprotein (LDL) cholesterol.
- The efficacy of such therapy in normocholesterolaemic patients with coronary heart disease (CHD) was previously unestablished.
Purpose of the Study:
- To investigate the impact of intensive lipid-lowering treatment on coronary atherosclerosis in patients with normal cholesterol levels but existing CHD.
- To determine if pharmacological intervention can yield angiographically measurable benefits in this patient group.
Main Methods:
- A randomized controlled trial involving 79 normocholesterolaemic CHD patients.
- Patients received diet therapy and were randomized to placebo or active treatment with stepwise lipid-lowering drugs (pravastatin, nicotinic acid, cholestyramine, gemfibrozil) to achieve specific lipid goals.
- Coronary angiograms were analyzed quantitatively at baseline and after 2.5 years.
Main Results:
- No significant difference in the progression of coronary atherosclerosis between the active treatment and placebo groups.
- Both groups showed similar significant narrowing of the mean minimum coronary artery diameter.
- Intensive treatment significantly altered plasma lipid concentrations (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apolipoprotein B) compared to placebo.
Conclusions:
- Intensive pharmacological lipid management in normocholesterolaemic CHD patients significantly impacts lipid profiles.
- However, this intensive treatment did not demonstrate any angiographically measurable benefit on coronary artery atherosclerosis progression in this population.