Abstract 3724: Optimal Control of Both Lipids and Blood Pressure is Required for Maximal Regression of Coronary Atherosclerosis
Background: Intensive lowering of LDL cholesterol has a beneficial impact on the rate of coronary plaque progression. The aim of this study was to evaluate whether optimal blood pressure control in addition to aggressive lipid control would further slow the rate of coronary plaque progression measured by intravascular ultrasound (IVUS).
Methods: Patients with established coronary disease who underwent serial IVUS examination in four studies (REVERSAL, NORMALISE, ACTIVATE and ASTEROID) were stratified into four subgroups based on systolic blood pressure (SBP) above or below 120 mmHg and LDL cholesterol level above or below 70 mg/dL. Subgroups were analyzed with respect to cardiovascular risk factors, and atherosclerotic plaque burden at baseline and during follow-up IVUS examination.
Results: The study population consisted of 1,324 patients with average systolic blood pressure of 131 mmHg and average LDL cholesterol of 86 mg/dL. Mean age was 57.5 years and patients were predominantly male (73.2%) with a high prevalence of risk factors (60.1% hypertension, 17.7% diabetes mellitus and 87.8% hyperlipidemia). In patients with SBP > 120 mmHg achieving LDL cholesterol < 70 mg/dL, reductions in total atheroma volume (TAV) (−6.25 ± 23.28 mm3 vs. 0.31 ± 23.84 mm3, p<0.001) and percent atheroma volume (PAV) (−0.20 ± 3.54% vs. 0.86 ± 4.14%, p<0.001) were observed. In patients with SBP < 120 mmHg achieving LDL cholesterol < 70 mg/dL, a similar reduction was seen in TAV (−6.34 ± 14.82 mm3 vs. −2.41 ± 22.30 mm3, p=0.105) and a greater reduction in PAV (−0.49 ± 2.20% vs. 0.87 ± 3.83%, p=0.001) was observed. Patients with SBP < 120 mmHg and LDL cholesterol < 70 mg/dL demonstrated a lower rate of substantial plaque progression (defined as > 5% increase in PAV, 10.8% vs. 23.3%, p=0.006) than patients with an SBP > 120 mmHg and LDL cholesterol < 70 mg/dL.
Conclusion: Optimal cholesterol management results in regression of coronary plaque even in patients who have achieved optimal blood pressure control. However, optimal blood pressure management may add incremental benefit to lipid management in slowing coronary plaque progression. These results highlight the importance of aggressively managing global cardiovascular risk in patients with established coronary artery disease.