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Effect of cholesterol reduction on myocardial ischemia in patients with coronary disease
1Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Insights
Lowering cholesterol with lovastatin significantly reduced myocardial ischemia in patients with coronary artery disease. This cholesterol-lowering therapy effectively resolved ischemia in a majority of treated individuals.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Cholesterol reduction is linked to decreased cardiovascular events.
- The impact of cholesterol lowering on daily myocardial ischemia requires further investigation.
Purpose of the Study:
- To assess if cholesterol lowering reduces myocardial ischemia during daily life.
- To evaluate the efficacy of lovastatin in managing ischemia in patients with coronary artery disease.
Main Methods:
- 40 patients with coronary artery disease and elevated cholesterol were randomized.
- Patients received either diet plus placebo or diet plus lovastatin for 4-6 months.
- Ambulatory ECG monitoring assessed episodes of ST-segment depression.
Main Results:
- The lovastatin group showed significantly lower total and LDL cholesterol.
- A significant reduction in ST-segment depression episodes was observed in the treatment group.
- Ischemia resolved completely in 65% of patients on lovastatin versus 10% on placebo.
Conclusions:
- Cholesterol lowering using lovastatin effectively eliminates myocardial ischemia in a significant patient subset.
- Lovastatin treatment, combined with diet, independently predicted ischemia resolution.
Background:
Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. This study sought to determine whether cholesterol lowering also results in a reduction of myocardial ischemia during daily life.
Methods And Results:
We enrolled 40 patients with proven coronary artery disease, total serum cholesterol between 191 and 327 mg/dL, and at least one episode of ST-segment depression on ambulatory ECG monitoring. Twenty patients were randomized to an American Heart Association Step 1 diet plus placebo (placebo group) and 20 to the same diet plus lovastatin (treatment group). Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4 to 6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. The treatment group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the placebo group. ST-segment depression was completely resolved in 13 of 20 patients (65%) in the treatment group versus 2 of 20 (10%) in the placebo group. The treatment group exhibited a highly significant reduction in ischemia (P < .001). By logistic regression, treatment with diet and lovastatin was an independent predictor of ischemia resolution.
Conclusions:
Cholesterol lowering with lovastatin appears to be effective in eliminating myocardial ischemia during daily life in a significant proportion of patients.