[Short- and long-term effects of intensified versus conventional antilipidemic therapy in patients with coronary heart disease. Results from the Lipid-Coronary Artery Disease (L-CAD) Study].
In a prospective, randomized study of patients with acute manifestation of coronary heart disease and hypercholesterolemia (LDL cholesterol >/= 130 </= 250 mg/dl), we compared the effect of an early-initiated, intensified therapy to usual care antilipidemic therapy with respect to coronary lesions and clinical events. Patients were included immediately following acute myocardial infarction and/or PTCA because of severe/instable angina pectoris. The intensified therapy consisted of pravastatin 20-40 mg with addition of colestyramine and/or nicotinic acid, if necessary, to achieve an LDL cholesterol </= 130 mg/dl. In the control group, antilipidemic therapy was left up to the private physician. The group with intensified therapy consisted of 70 patients (LDL cholesterol 179 +/- 27 mg/dl, age 55 +/- 10 years, 81% males), the control group of 56 patients (LDL cholesterol 177 +/- 28 mg/dl, age 58 +/- 11 years, 79% males). Cholesterol was reduced longterm by 28% under intensified therapy, but it remained constant in the control group. Quantitative coronary angiography revealed a mean of increase minimal lumen diameter of 0.05 mm after 6 months with intensified therapy and of 0.13 mm after 24 months. Under conventional therapy, however, it decreased by 0.08 mm after 6 months, and by 0.18 mm after 24 months (p < 0.01). In addition, within 12 months of therapy, significantly (p < 0.01) less cardiovascular clinical events were observed in patients under intensified therapy. After 2 years 43% (n = 22) of the controls, but only 17% (n = 14) of the patients with intensified therapy experienced a major clinical event (p < 0.03), i. e. death, myocardial infarction, necessary coronary intervention, cerebral infarction or new peripheral vascular disease. This study is the first to show that aggressive early - initiated cholesterol-lowering therapy can induce regression and reduce progression of coronary lesions already after 6 months. These changes are accompanied by a significant reduction in clinical events. The results of our study underline the necessity of immediate cholesterol screening and early intensive antilipemic therapy at the latest when of coronary heart disease becomes manifest.
Arntz
H R
HR
Med. Klinik II, Universitätsklinikum Benjamin Franklin der Freien Universität Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
Wunderlich
W
W
Schnitzer
L
L
Stern
R
R
Fischer
F
F
Agrawal
R
R
Linderer
T
T
Schultheiss
H P
HP
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000188:drug therapy; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D008078:Cholesterol, LDL / Q000097:blood; D002792:Cholestyramine Resin / Q000008:administration & dosage / Q000009:adverse effects; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy*; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy; D009525:Niacin / Q000008:administration & dosage / Q000009:adverse effects; D017035:Pravastatin / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL; D002792:Cholestyramine Resin; D009525:Niacin; D017035:Pravastatin