title: Intensively lowering both low-density lipoprotein cholesterol and blood pressure does not reduce cardiovascular risk in Japanese coronary artery disease patients.
abstract: BACKGROUND
  Despite mounting evidence of the benefit of intensive lowering of low-density lipoprotein-cholesterol (LDL-C) in coronary artery disease (CAD) patients, it has not been shown that intensive lowering of both LDL-C and blood pressure (BP) reduces cardiovascular events in these patients.
  
  
  RESULTS
  498 patients with hypertension and hypercholesterolemia with ≥ 75% stenosis in at least one major coronary artery, were recruited from 17 cardiovascular centers in eastern Japan. Patients were randomly assigned to conventional therapy (CT) or intensive therapy (IT). CT aimed to reduce BP to < 140/90 mm Hg and LDL-C to <100mg/dl, and IT aimed for < 120/80 mm Hg and < 80 mg/dl, respectively. The primary endpoint was a composite of all deaths, non-fatal myocardial infarction, unstable angina pectoris, coronary artery bypass graft surgery, non-fatal stroke, non-fatal major vascular disease, and peripheral artery disease. The mean follow-up period was 3.2 years. The achieved systolic BP was 126.8 mm Hg for the CT group, and 121.3 mm Hg for the IT group (P < 0.001). The achieved LDL-C was 92.1mg/dl for the CT group, and 79.6 mg/dl for the IT group (P < 0.001). We detected the primary endpoint in 18 (7.1%) patients in the CT group, and 26 (10.7%) in the IT group (hazard ratio 1.53, 95% confidence interval 0.84-2.80, P = 0.164).
  
  
  CONCLUSIONS
  We could not show that intensively lowering both BP and LDL-C reduced cardiovascular risks in Japanese CAD patients with hypertension and hypercholesterolemia (UMIN-CTR UMIN000000571).
authors.affiliation: Department of Translational Research for Healthcare and Clinical Science, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takahide
authors.initials: T
authors.lastname: Kohro
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kurabayashi
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Taiki
authors.initials: T
authors.lastname: Tojo
authors.forename: Ryozo
authors.initials: R
authors.lastname: Nagai
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People; D001794:Blood Pressure; D008078:Cholesterol, LDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D023921:Coronary Stenosis / Q000097:blood* / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D007564:Japan; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D008078:Cholesterol, LDL