TY - JOUR
T1 - Low Levels of Low-Density Lipoprotein Cholesterol and Blood Pressure and Progression of Coronary Atherosclerosis
AU - Chhatriwalla, Adnan K.
AU - Nicholls, Stephen J.
AU - Wang, Thomas H.
AU - Wolski, Kathy
AU - Sipahi, Ilke
AU - Crowe, Tim
AU - Schoenhagen, Paul
AU - Kapadia, Samir
AU - Tuzcu, E. Murat
AU - Nissen, Steven E.
N1 - Funding Information:
Dr. Nicholls received honoraria from Pfizer, AstraZeneca, Takeda, and Merck Schering-Plough; consulting fees from AstraZeneca, Roche, Merck Schering-Plough, Takeda, Pfizer, and Anthera Pharmaceuticals; and research support from AstraZeneca and LipidSciences. Dr. Sipahi received an educational grant from Pfizer. Dr. Kapadia received honoraria from Pfizer. Dr. Schoenhagen received honoraria from Takeda Pharmaceuticals (directly paid to higher education and charity). Dr. Nissen received research support from AstraZeneca, Eli Lilly, Pfizer, Takeda, Sankyo, and Sanofi-Aventis. Dr. Nissen pays all honoraria, consulting fees, or other payments from any for-profit entity directly to charity, so that neither income nor any tax deduction is received. The REVERSAL, CAMELOT, and ILLUSTRATE studies were sponsored by Pfizer. The ASTEROID trial was sponsored by AstraZeneca. The ACTIVATE trial was sponsored by Sankyo Pharma. The PERISCOPE trial was sponsored by Takeda. The STRADIVARIUS trial was sponsored by Sanofi-Aventis.
PY - 2009/3/31
Y1 - 2009/3/31
N2 - Objectives: We investigated coronary atheroma progression in patients with low levels of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP). Background: Low LDL-C and SBP beneficially impact coronary atherosclerosis. However, the association between intensive control of both risk factors and coronary plaque progression remains unclear. Methods: Changes in atheroma burden monitored by intravascular ultrasound were studied in 3,437 patients with coronary artery disease (CAD) who were stratified according to on-treatment LDL-C and SBP. Results: Patients with very low LDL-C (≤70 mg/dl) and normal SBP (≤120 mm Hg) had less progression in percent atheroma volume (PAV) (p < 0.001) and total atheroma volume (TAV) (p < 0.001), more frequent plaque regression (p = 0.01), and less frequent plaque progression (p < 0.001). In patients with SBP >120 mm Hg, very low LDL-C was associated with less progression of PAV (+0.30%, 95% confidence interval [CI]: -0.17% to 0.77% vs. +0.61%, 95% CI: 0.17% to 1.05%, p = 0.01) and TAV (-3.9 mm3, 95% CI: -7.24 to -0.63 mm3 vs. -1.2 mm3, 95% CI: -4.31 to 1.92 mm3, p = 0.001). In patients with LDL-C >70 mg/dl, normal SBP was not associated with less progression of PAV (+0.51%, 95% CI: 0.04% to 0.99% vs. +0.61%, 95% CI: 0.17% to 1.05%, p = 0.159) or TAV (-2.3 mm3, 95% CI: -5.59 to 1.05 mm3 vs. -1.2 mm3, 95% CI: -4.31 to 1.92 mm3, p = 0.617). Conclusions: Very low LDL-C and normal SBP are associated with the slowest progression of coronary atherosclerosis. Although a greater beneficial association is observed in patients with very low LDL-C, these findings suggest the need for intensive control of global risk in patients with CAD.
AB - Objectives: We investigated coronary atheroma progression in patients with low levels of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP). Background: Low LDL-C and SBP beneficially impact coronary atherosclerosis. However, the association between intensive control of both risk factors and coronary plaque progression remains unclear. Methods: Changes in atheroma burden monitored by intravascular ultrasound were studied in 3,437 patients with coronary artery disease (CAD) who were stratified according to on-treatment LDL-C and SBP. Results: Patients with very low LDL-C (≤70 mg/dl) and normal SBP (≤120 mm Hg) had less progression in percent atheroma volume (PAV) (p < 0.001) and total atheroma volume (TAV) (p < 0.001), more frequent plaque regression (p = 0.01), and less frequent plaque progression (p < 0.001). In patients with SBP >120 mm Hg, very low LDL-C was associated with less progression of PAV (+0.30%, 95% confidence interval [CI]: -0.17% to 0.77% vs. +0.61%, 95% CI: 0.17% to 1.05%, p = 0.01) and TAV (-3.9 mm3, 95% CI: -7.24 to -0.63 mm3 vs. -1.2 mm3, 95% CI: -4.31 to 1.92 mm3, p = 0.001). In patients with LDL-C >70 mg/dl, normal SBP was not associated with less progression of PAV (+0.51%, 95% CI: 0.04% to 0.99% vs. +0.61%, 95% CI: 0.17% to 1.05%, p = 0.159) or TAV (-2.3 mm3, 95% CI: -5.59 to 1.05 mm3 vs. -1.2 mm3, 95% CI: -4.31 to 1.92 mm3, p = 0.617). Conclusions: Very low LDL-C and normal SBP are associated with the slowest progression of coronary atherosclerosis. Although a greater beneficial association is observed in patients with very low LDL-C, these findings suggest the need for intensive control of global risk in patients with CAD.
KW - LDL-C
KW - atherosclerosis
KW - blood pressure
KW - cholesterol
KW - coronary artery disease
KW - hypertension
KW - intravascular ultrasound
UR - http://www.scopus.com/inward/record.url?scp=62549157770&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2008.09.065
DO - 10.1016/j.jacc.2008.09.065
M3 - Article
C2 - 19324254
AN - SCOPUS:62549157770
SN - 0735-1097
VL - 53
SP - 1110
EP - 1115
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -