Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B
Brown G, Albers JJ, Fisher LD, Schaefer SM, Lin JT, Kaplan C, Zhao XQ, Bisson BD, Fitzpatrick VF, Dodge HT
The New England journal of medicine · 1,347 citas
Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Heart, Lung, and Blood Institute
- Gobierno
- National Center for Research Resources
- Gobierno
- NCRR NIH HHS
- Gobierno
- NHLBI NIH HHS
- Subvenciones
- National Heart, Lung, and Blood Institute (R01 HL 19451); National Center for Research Resources (RR 37); National Heart, Lung, and Blood Institute (P01 HL-30086)
Según 4 financiadores declarados.
Publicación
- Publicado
- 1990-11-08 · N Engl J Med · vol. 323 · número 19 · págs. 1289–1298
- Editorial
- Massachusetts Medical Society
- Citado
- 2,153 citas · más que el 100% de estudios similares · 184.4× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 53 trabajos
- Acceso
- Lectura gratuita
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Atherosclerosis and Cardiovascular Diseases
- Palabras clave
- coronary artery disease, apolipoprotein B, intensive lipid-lowering therapy, lovastatin, nicotinic acid, colestipol, LDL cholesterol, HDL cholesterol, systolic blood pressure, cardiovascular events, revascularization, myocardial infarction, mortality, nutrition counseling
- MeSH
- humans, coronary disease, colestipol, niacin, lovastatin, apolipoproteins b, coronary angiography, drug therapy, combination, diet, multivariate analysis, double-blind method, adult, middle aged, male, cholesterol, ldl, cholesterol, hdl
10 autores
- Greg Brown🇺🇸University of Washington
- John J. Albers🇺🇸University of Washington
- Lloyd D. Fisher🇺🇸University of Washington
- Susan M. Schaefer
- Jiin-Tarng Lin
- Cheryl Kaplan🇺🇸University of Washington
- Xue-Qiao Zhao
- Brad Bisson
- Virginia Fitzpatrick🇺🇸University of Washington
- Harold T. Dodge
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background and methods
The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2 1/2-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments: lovastatin (20 mg twice a day) and colestipol (10 g three times a day); niacin (1 g four times a day) and colestipol (10 g three times a day); or conventional therapy with placebo (or colestipol if the low-density lipoprotein [LDL] cholesterol level was elevated).
Results
The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7 and +5 percent, respectively), but more substantially among patients treated with lovastatin and colestipol (-46 and +15 percent) or niacin and colestipol (-32 and +43 percent). In the conventional-therapy group, 46 percent of the patients had definite lesion progression (and no regression) in at least one of nine proximal coronary segments; regression was the only change in 11 percent. By comparison, progression (as the only change) was less frequent among patients who received lovastatin and colestipol (21 percent) and those who received niacin and colestipol (25 percent), and regression was more frequent (lovastatin and colestipol, 32 percent; niacin and colestipol, 39 percent; P less than 0.005). Multivariate analysis indicated that a reduction in the level of apolipoprotein B (or LDL cholesterol) and in systolic blood pressure, and an increase in HDL cholesterol correlated independently with regression of coronary lesions. Clinical events (death, myocardial infarction, or revascularization for worsening symptoms) occurred in 10 of 52 patients assigned to conventional therapy, as compared with 3 of 46 assigned to receive lovastatin and colestipol and 2 of 48 assigned to receive niacin and colestipol (relative risk of an event during intensive treatment, 0.27; 95 percent confidence interval, 0.10 to 0.77).
Conclusions
In men with coronary artery disease who were at high risk for cardiovascular events, intensive lipid-lowering therapy reduced the frequency of progression of coronary lesions, increased the frequency of regression, and reduced the incidence of cardiovascular events.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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