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Regression of severe atherosclerotic plaque in patients with mild elevation of LDL cholesterol
S Schaefer1, H Hussein, G R Gershony
1Division of Cardiovascular Medicine, University of California, Davis 95616, USA.
Insights
Intensive risk factor reduction improved coronary artery morphology in patients with mild dyslipidemia, leading to regression of severe lesions but not preventing progression of mild ones.
Area of Science:
- Cardiology
- Preventive Medicine
- Medical Interventions
Background:
- Intensive risk factor reduction in patients with dyslipidemias and coronary atherosclerosis can alter coronary artery morphology and reduce clinical events.
- The effect of these interventions on individuals with normal low-density lipoprotein (LDL) levels is not well understood.
Purpose of the Study:
- To investigate if intensive risk factor reduction leads to angiographic regression in patients with mildly elevated LDL levels.
- To assess the impact of a 2-year intensive treatment program on coronary artery diameter in patients with coronary atherosclerosis and mild dyslipidemia.
Main Methods:
- 14 patients with angiographically proven coronary atherosclerosis and mildly elevated LDL were enrolled in a 2-year intensive treatment program.
- The program included pharmacologic and nonpharmacologic interventions, such as dietary changes.
- Quantitative angiography was performed before and after the 2-year intervention period to measure changes in coronary artery diameter.
Main Results:
- Dietary fat intake decreased by 58%, and LDL levels reduced from 120 +/- 7 mg/dL to 104 +/- 6 mg/dL (p = 0.05).
- Overall arterial diameter increased by +0.05 +/- 0.04 mm after 24 months (p = 0.01), indicating regression.
- Severe lesions (>50% stenosis) regressed, while mild lesions (<20% stenosis) showed progression.
Conclusions:
- Intensive risk factor reduction in patients with mild dyslipidemia promotes regression of more severe coronary lesions.
- The interventions did not prevent the progression of mild coronary lesions.
- Beneficial effects on the morphology of severe lesions were observed with intensive risk factor reduction in patients with mild lipid elevations.
Background:
Intensive risk factor reduction in patients with dyslipidemias and coronary atherosclerosis has been shown to result in alterations in coronary artery morphology and reduced clinical events. However, the impact of such interventions in populations with relatively normal levels of low-density lipoproteins (LDL) is unclear.
Methods:
To test the hypothesis that intensive risk factor reduction results in angiographic regression in patients with only mildly elevated levels of LDL, 14 patients with angiographically proven coronary atherosclerosis were entered into the University of California Davis Coronary Artery Disease Regression Program and intensively treated with pharmacologic and nonpharmacologic interventions for 2 years. Quantitative angiography was performed prior to and after 2 years of therapy to determine changes in coronary artery diameter.
Results:
As a result of this program, dietary fat intake was reduced by 58% and LDL fell from 120 +/- 7 mg/dL to 104 +/- 6 mg/dL (p = 0.05). The average diameter of the measured arterial locations (including all 53 stenoses and 292 nondiscrete regions) on study entry was 2.74 +/- 0.05 mm. After 24 months, there was a net increase in arterial diameter (regression) of +0.05 +/- 0.04 mm to 2.81 +/- 0.05 mm (p = 0.01). While there was no significant change in the average diameter of discrete stenoses, all 8 lesions > or = 50% initial diameter narrowing regressed, with a mean diameter change of + 0.2 mm. Conversely, only 1 of 8 mild lesions < or = 20% regressed, while 4 progressed. Intermediate lesions (20% to 50%, n = 37) had balanced progression and regression.
Conclusions:
When examined as a continuous variable, there was a significant linear correlation between initial lesion severity (% stenosis) and the extent of regression (mm). Therefore, risk factor reduction (dietary therapy, exercise, psycho-social counseling, and lipid lowering therapy) in patients with only mild dyslipidemia results in angiographic regression of more severe lesions (> 50% initial stenosis), but does not prevent progression of mild lesions (< 20%). These findings demonstrate that intensive risk factor reduction in patients with only mild elevation of lipids beneficially influences the morphology of the most severe lesions.