Abstract 13108: Intensive Multi-target Lipid Lowering and Progression of Coronary Atherosclerosis
Background: The current guidelines recommend targeting low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) in the management of coronary disease patients (CAD). In practice, lipid targets are met in less than a third of CAD patients and non-HDL-C is often neglected as a treatment target. We aimed to determine the effect of very intensive lipid lowering targeting both LDL-C and non-HDL-C on atheroma progression.
Methods: We studied coronary atherosclerosis progression in 2046 patients with serial intravascular ultrasound. Patients were stratified according to on-treatment LDL-C and non-HDL-C levels (Table). Groups were compared for baseline disease burden and progression rates of atherosclerosis.
Results: Findings are summarized in table below. Very intensive lowering of both LDL-C and non-HDL-C was associated with less progression of percent atheroma volume (p<0.001) and total atheroma volume (p=0.001), more frequent plaque regression (p=0.001) and less frequent plaque progression (p<0.001). There was a graded relationship between the intensity of lipid lowering, the number of lipid targets met and atheroma progression which persisted in multivariable analysis (p<0.001 and 0.004 for change in PAV and TAV respectively)
Conclusion: Very intensive lipid lowering targeting LDL-C<70 mg/dl and non-HDL-C<100 mg/dl is associated with the slowest progression rates of coronary atherosclerosis. Our findings emphasize the importance of strict adherence to the guidelines on lipid management and even more the need for more intensive lipid lowering in high risk patients.
- © 2010 by American Heart Association, Inc.