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

被引:41
作者
White, CW
Gobel, FL
Campeau, L
Knatterud, GL
Forman, SA
Forrester, JS
Geller, NL
Herd, JA
Hickey, A
Hoogwerf, BJ
Hunninghake, DB
Rosenberg, Y
Terrin, ML
机构
[1] Maryland Med Res Inst, Post CABG Coordinating Ctr, Baltimore, MD 21210 USA
[2] Univ Minnesota, Minneapolis, MN USA
[3] Minneapolis Heart Inst Fdn, Minneapolis, MN USA
[4] Montreal Heart Inst, Montreal, PQ H1T 1C8, Canada
[5] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA
[6] Baylor Coll Med, Houston, TX 77030 USA
[7] Cleveland Clin Fdn, Cleveland, OH 44195 USA
[8] NHLBI, Off Biostat Res, Bethesda, MD 20892 USA
[9] NHLBI, Clin Trials Grp, Bethesda, MD 20892 USA
关键词
coronary disease; lipids; cholesterol; angiography;
D O I
10.1161/hc4701.099730
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering re-imens and low-dose anticoaculation versus lacebo 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). Methods and 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.
引用
收藏
页码:2660 / 2665
页数:6
相关论文
共 28 条
[1]  
[Anonymous], 1994, CIRCULATION
[2]   Progression of coronary artery disease predicts clinical coronary events - Long-term follow-up from the Cholesterol Lowering Atherosclerosis Study [J].
Azen, SP ;
Mack, WJ ;
CashinHemphill, L ;
LaBree, L ;
Shircore, AM ;
Selzer, RH ;
Blankenhorn, DH ;
Hodis, HN .
CIRCULATION, 1996, 93 (01) :34-41
[3]  
BOURASSA MG, 1978, CIRCULATION, V58, P100
[4]   CHANGES IN SEQUENTIAL CORONARY ARTERIOGRAMS AND SUBSEQUENT CORONARY EVENTS [J].
BUCHWALD, H ;
MATTS, JP ;
FITCH, LL ;
CAMPOS, CT ;
SANMARCO, ME ;
AMPLATZ, K ;
CASTANEDAZUNIGA, WR ;
HUNTER, DW ;
PEARCE, MB ;
BISSETT, JK ;
EDMISTON, WA ;
SAWIN, HS ;
WEBER, FJ ;
VARCO, RL ;
CAMPBELL, GS ;
YELLIN, AE ;
SMINK, RD ;
LONG, JM ;
HANSEN, BJ ;
CHALMERS, TC ;
MEIER, P ;
STAMLER, J .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 268 (11) :1429-1433
[5]   WOMEN IN THE POSCH TRIAL - EFFECTS OF AGGRESSIVE CHOLESTEROL MODIFICATION IN WOMEN WITH CORONARY HEART-DISEASE [J].
BUCHWALD, H ;
CAMPOS, CT ;
MATTS, JP ;
FITCH, LL ;
LONG, JM ;
VARCO, RL .
ANNALS OF SURGERY, 1992, 216 (04) :389-400
[6]   Aggressive cholesterol lowering delays saphenous vein graft atherosclerosis in women, the elderly, and patients with associated risk factors - NHLBI post coronary artery bypass graft clinical trial [J].
Campeau, L ;
Hunninghake, DB ;
Knatterud, GL ;
White, CW ;
Domanski, M ;
Forman, SA ;
Forrester, JS ;
Geller, NL ;
Gobel, FL ;
Herd, JA ;
Hoogwerf, BJ ;
Rosenberg, Y .
CIRCULATION, 1999, 99 (25) :3241-3247
[7]  
Campeau L, 1997, NEW ENGL J MED, V336, P153
[8]   Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels - Results of AFCAPS/TexCAPS [J].
Downs, JR ;
Clearfield, M ;
Weis, S ;
Whitney, E ;
Shapiro, DR ;
Beere, PA ;
Langendorfer, A ;
Stein, EA ;
Kruyer, W ;
Gotto, AM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 279 (20) :1615-1622
[9]  
Fuster V, 1997, LANCET, V350, P389
[10]  
Gobel FL, 1998, CATHETER CARDIO DIAG, V45, P376, DOI 10.1002/(SICI)1097-0304(199812)45:4<376::AID-CCD5>3.0.CO