(Circulation. 1995;92:2404-2410.)
© 1995 American Heart Association, Inc.
Articles |
Effects of Cholesterol Lowering on the Progression of Coronary Atherosclerosis in Women
A Canadian Coronary Atherosclerosis Intervention Trial (CCAIT) Substudy
Presented in part at the American College of Cardiology 43rd Annual Scientific Session, Atlanta, Georgia, March 13-17, 1994, and published in abstract form (J Am Coll Cardiol. 1994;23:455A).
Correspondence to David Waters, MD, Division of Cardiology, Hartford Hospital, 80 Seymour St, Hartford, CT 06102-5037.
Background Although coronary disease is the leading cause of death in women and its clinical features differ from those in men, very few women have been included in angiographic trials of cholesterol lowering.
Methods and Results Sixty-two women with diffuse but
not necessarily severe coronary atherosclerosis
documented on a recent angiogram and with fasting serum
cholesterol between 220 and 300 mg/dL were enrolled in a
double-blind, placebo-controlled trial. More than one half had
a history of hypertension, approximately one quarter were diabetics,
and one third were current smokers. All women received dietary
counseling. Lovastatin or placebo was begun at 20 mg/d and
was titrated if necessary to 40 and then to 80 mg during the first 16
weeks to attain a fasting LDL cholesterol 
130 mg/dL. The
mean lovastatin dose was 34 mg/d. Total and LDL
cholesterol decreased by 24% and 32%, respectively, in
lovastatin-treated women but by <3% in women
receiving placebo. Coronary arteriography was repeated after 2
years in 54 women (87%), and their 394 lesions were measured
"blindly" on pairs of film with an automated computerized
quantitative system. Progression, defined as a worsening in minimum
diameter of one or more stenoses by 
0.4 mm, occurred in 7 of
25 lovastatin-treated women and 17 of 29
placebo-treated women (28% versus 59%, P=.031). New
coronary lesions developed in 1
lovastatin-treated woman and 13 placebo-treated
women (4% versus 45%, P<.001). The outcome for each of
the angiographic end points was not significantly different between the
women and the 245 men who completed the trial.
Conclusions Lovastatin slows the progression of coronary atherosclerosis and prevents the development of new coronary lesions in women.
Key Words: atherosclerosis • women • coronary disease • cholesterol
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