(Circulation. 2000;102:1748.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Long-Term Effects of Cholesterol Lowering and Angiotensin-Converting Enzyme Inhibition on Coronary Atherosclerosis
The Simvastatin/Enalapril Coronary Atherosclerosis Trial (SCAT)
From the University of Alberta Hospitals, Edmonton, Alberta (K.K.T., J.R.B., W.T., V.D., D.T., S.Y., T.J.M.); Vancouver Hospital and Health Sciences Centre, Vancouver (C.E.B); Hôpital Laval, Ste-Foy, Quebec (S.P.); and the Epidemiology Coordinating and Research (EPICORE) Centre, Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta (K.K.T., J.R.B., D.C., W.Y., V.D., D.T., T.J.M.), Canada. Dr Teo is currently affiliated with the Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Dr Catellier with the Department of Biostatistics, University of North Carolina, Chapel Hill; Dr Yokoyama with Biochemistry 1, Nagoya City University Medical School, Nagoya, Japan; and Dr Montague with Merck Frosst Canada & Co, Kirkland, Quebec, Canada.
Correspondence to Dr Koon K. Teo, Rm 3U4, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. E-mail teok{at}fhs.mcmaster.ca
Background—This long-term, multicenter, randomized, double-blind, placebo-controlled, 2x2 factorial, angiographic trial evaluated the effects of cholesterol lowering and angiotensin-converting enzyme inhibition on coronary atherosclerosis in normocholesterolemic patients.
Methods and Results—There were a total of 460 patients: 230 received simvastatin and 230, a simvastatin placebo, and 229 received enalapril and 231, an enalapril placebo (some subjects received both drugs and some received a double placebo). Mean baseline measurements were as follows: cholesterol level, 5.20 mmol/L; triglyceride level, 1.82 mmol/L; HDL, 0.99 mmol/L; and LDL, 3.36 mmol/L. Average follow-up was 47.8 months. Changes in quantitative coronary angiographic measures between simvastatin and placebo, respectively, were as follows: mean diameters, -0.07 versus -0.14 mm (P=0.004); minimum diameters, -0.09 versus -0.16 mm (P=0.0001); and percent diameter stenosis, 1.67% versus 3.83% (P=0.0003). These benefits were not observed in patients on enalapril when compared with placebo. No additional benefits were seen in the group receiving both drugs. Simvastatin patients had less need for percutaneous transluminal coronary angioplasty (8 versus 21 events; P=0.020), and fewer enalapril patients experienced the combined end point of death/myocardial infarction/stroke (16 versus 30; P=0.043) than their respective placebo patients.
Conclusions—This trial extends the observation of the beneficial angiographic effects of lipid-lowering therapy to normocholesterolemic patients. The implications of the neutral angiographic effects of angiotensin-converting enzyme inhibition are uncertain, but they deserve further investigation in light of the positive clinical benefits suggested here and seen elsewhere.
Key Words: atherosclerosis • coronary disease • cholesterol • angiotensin-converting enzyme inhibitors
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