Regression of Coronary Atherosclerosis During Treatment of Familial Hypercholesterolemia With Combined Drug Regimens

Abstract

We conducted a randomized, controlled trial in 72 patients with heterozygous familial hypercholesterolemia to test whether reducing plasma low-density lipoprotein levels by diet and combined drug regimens can induce regression of coronary lesions. Four hundred fifty-seven lesions were measured before and after a 26-month interval by computer-based quantitative angiography. The primary outcome variable was within-patient mean change in percent area stenosis. Mean low-density lipoprotein cholesterol levels decreased from 7.32 +/- 1.5 to 4.45 +/- 1.6 mmol/L. The mean change in percent area stenosis among controls was +0.80, indicating progression, while the mean change for the treatment group was -1.53, indicating regression (P = .039 by two-tailed t test for the difference between groups). Regression among women, analyzed separately, was also significant. The change in percent area stenosis was correlated with low-density lipoprotein levels on trial. We conclude that reduction of low-density lipoprotein cholesterol levels can induce regression of atherosclerotic lesions of the coronary arteries in patients with familial hypercholesterolemia. The anticipation of benefit from treatment applies to women and men alike.

Secondary prevention of heart disease amongst patients with lipid abnormalities: practice and trends in the United States

“…HARP [27], and CCAIT, [28], and CARE [29], call into question the merits of treating patients with more normal lipid levels, although CLAS [30] and FATS [31,32] support this approach. When women have been included in these studies [33,34] the arterial treatment benefits were comparable, or superior, to those of men.…”

Vastatinas na prevenção da doença aterosclerótica: dados atuais

“…Para estudar a interferência da redução do LDL-c (colesterol ligado à LDL) nas lesões ateroscleróticas das artérias coronárias, avaliadas por angiografia, as vastatinas foram utilizadas isoladamente ou associadas a outros fármacos hipolipemiantes ou a afé-rese [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (tab. I).…”

Cholesterol management in women and the elderly

“…More recently, studies of serial coronary angiograms in men and women have indicated that LDL-C lowering and HDL-C increasing were associated with the arrest of progression of atherosclerosis and reduction in CAD events both in women and in men [11][12][13]. Finally, in the recent Scandinavian Simvastatin Survival Study (4S), women with CAD had the same reduction in coronary events as men, although an effect on mortality (as a result of low numbers of deaths in women) could not be demonstrated [14].…”

“…Certainly in both men and women with established coronary disease, lowering of LDL levels is an essential component of therapy [11][12][13]. As a reflection of that belief, NCEP guidelines suggest that LDL targets for such individuals should be set very low, i.e.…”