Intensive LOwering of BlOod pressure and low-density lipoprotein ChOlesterol with statin theraPy (LOBOCOP) may improve neointimal formation after coronary stenting in patients with coronary artery disease.
OBJECTIVE
This prospective study was carried out to evaluate the benefits of intensive lowering of low-density lipoprotein cholesterol (LDL-C) with statin and intensive blood pressure (BP)-lowering therapy as aggressive medical interventions after stent implantation.


METHODS
Fifty-four patients with coronary artery disease initially received statin immediately after successful stent implantation. They were divided into intensive therapy (IT group, n = 27; therapeutic target levels of LDL-C and BP were 60 mg/dl and <120/80 mmHg at follow-up coronary angiography, respectively, 6-8 months after stent implantation) and conventional therapy groups (CT group, n = 27; target levels of LDL-C and BP were 100 mg/dl and <130/85 mmHg, respectively). Additional antihypertensive therapy with angiotensin II type 1 receptor blockers was begun according to the BP levels.


RESULTS
There were significant differences in the levels of LDL-C at follow-up between the IT and CT groups [average, 68+/-10 (cut-off value,>or=83.4) mg/dl and 102+/-14 (<83.4) mg/dl, respectively]. Percentage diameter stenosis (P = 0.039) and diastolic BP (P = 0.005) in the IT group were significantly decreased compared with those in the CT group at follow-up. In addition, percentage diameter stenosis was most significantly related to the level of LDL-C (P = 0.03) among other metabolic factors (BP, body mass index, triglyceride, high-density lipoprotein cholesterol, hemoglobin A1c, and adiponectin) at follow-up as assessed by a stepwise multivariable regression analysis.


CONCLUSIONS
These results suggest that intensive lowering of LDL-C by statin decreased the neointimal formation after stent implantation, and an LDL-C level of at least 83.4 mg/dl was the most acceptable clinical therapeutic target at follow-up.
Takamiya
Yosuke
Y
Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan.
Miura
Shin-Ichiro
S
Kawamura
Akira
A
Tanigawa
Hiroyuki
H
Zhang
Bo
B
Iwata
Atsushi
A
Nishikawa
Hiroaki
H
Matsuo
Kunihiro
K
Shirai
Kazuyuki
K
Saku
Keijiro
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D008078:Cholesterol, LDL / Q000097:blood*; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D015536:Down-Regulation; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging
D000959:Antihypertensive Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors