title: Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study.
abstract: The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0 ± 9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18-24 months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100 mg/dL and 140/90 mmHg vs. 70 mg/dL and 120/70 mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9 ± 14.7 vs. 63.7 ± 11.9 mg/dL (NS) and 124.1 ± 9.4/75.8 ± 7.7 vs. 113.6 ± 9.6/65.8 ± 9.4 mmHg (systolic BP; NS, diastolic BP; p < 0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of -9.4 ± 10.7% and -8.7 ± 8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Masa-Aki
authors: MA
authors: Kawashiri
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Kenji
authors: K
authors: Sakata
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Kenshi
authors: K
authors: Hayashi
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Tadatsugu
authors: T
authors: Gamou
authors: Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors: Honin
authors: H
authors: Kanaya
authors: Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors: Kenji
authors: K
authors: Miwa
authors: Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan.
authors: Kosei
authors: K
authors: Ueda
authors: Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan.
authors: Toshinori
authors: T
authors: Higashikata
authors: Department of Cardiology, Fukui Cardiovascular Center, Fukui, Japan.
authors: Sumio
authors: S
authors: Mizuno
authors: Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan.
authors: Ichiro
authors: I
authors: Michishita
authors: Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan.
authors: Masanobu
authors: M
authors: Namura
authors: Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan.
authors: Yutaka
authors: Y
authors: Nitta
authors: Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan.
authors: Shoji
authors: S
authors: Katsuda
authors: Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan.
authors: Kazuyasu
authors: K
authors: Okeie
authors: Department of Internal Medicine, Takaoka Municipal Hospital, Takaoka, Japan.
authors: Hiroaki
authors: H
authors: Hirase
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Hayato
authors: H
authors: Tada
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Katsuharu
authors: K
authors: Uchiyama
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
authors: Tetsuo
authors: T
authors: Konno
authors: Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan.
authors: Hidekazu
authors: H
authors: Ino
authors: Division of Medical Sciences, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
authors: Keisuke
authors: K
authors: Nagase
authors: Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan. myamagi@med.kanazawa-u.ac.jp.
authors: Masakazu
authors: M
authors: Yamagishi
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011446:Prospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents; D008055:Lipids
keywords: Amlodipine; Atorvastatin; Coronary plaque volume; Intravascular ultrasound