title: Effect of an aggressive lipid-lowering strategy on progression of atherosclerosis in the left main coronary artery from patients in the post coronary artery bypass graft trial.
abstract: BACKGROUND
  The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering regimens and low-dose anticoagulation versus placebo on progression of atherosclerosis in saphenous vein grafts of patients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol levels to a mean yearly cholesterol level from 93 to 97 mg/dL compared with a moderate reduction to a level of 132 to 136 mg/dL decreased the progression of atherosclerosis in saphenous vein grafts. Low-dose anticoagulation did not affect progression. This secondary analysis tested the hypothesis that a similar decrease in progression of atherosclerosis would also be present in native coronary arteries as measured in the left main coronary artery (LMCA).
  
  
  RESULTS
  A sample of 402 patients was randomly selected from 1102 patients who had baseline and follow-up views of the LMCA suitable for analysis. Patients treated with the aggressive lipid-lowering strategy had less progression of atherosclerosis in the LMCA as measured by changes in minimum (P=0.0003) lumen diameter or the maximum percent stenosis (P=0.001), or the presence of substantial progression (P=0.008), or vascular occlusion (P=0.005) when compared with the moderate strategy.
  
  
  CONCLUSIONS
  A strategy of aggressive lipid lowering results in significantly less atherosclerosis progression than a moderate approach in LMCAs.
authors.affiliation: University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: C W
authors.initials: CW
authors.lastname: White
authors.forename: F L
authors.initials: FL
authors.lastname: Gobel
authors.forename: L
authors.initials: L
authors.lastname: Campeau
authors.forename: G L
authors.initials: GL
authors.lastname: Knatterud
authors.forename: S A
authors.initials: SA
authors.lastname: Forman
authors.forename: J S
authors.initials: JS
authors.lastname: Forrester
authors.forename: N L
authors.initials: NL
authors.lastname: Geller
authors.forename: J A
authors.initials: JA
authors.lastname: Herd
authors.forename: A
authors.initials: A
authors.lastname: Hickey
authors.forename: B J
authors.initials: BJ
authors.lastname: Hoogwerf
authors.forename: D B
authors.initials: DB
authors.lastname: Hunninghake
authors.forename: Y
authors.initials: Y
authors.lastname: Rosenberg
authors.forename: M L
authors.initials: ML
authors.lastname: Terrin
mesh_terms: D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D002792:Cholestyramine Resin / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D003331:Coronary Vessels / Q000187:drug effects* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008055:Lipids / Q000097:blood; D008148:Lovastatin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012501:Saphenous Vein / Q000637:transplantation; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D000925:Anticoagulants; D008078:Cholesterol, LDL; D008055:Lipids; D002792:Cholestyramine Resin; D008148:Lovastatin