low cholesterol halts atherosclerosis

From: Doug Skrecky (oberon@vcn.bc.ca)
Date: Thu Nov 19 1998 - 13:47:51 MST


Authors
  MacMahon S. Sharpe N. Gamble G. Hart H. Scott J. Simes J. White H.
Institution
  Department of Medicine, University of Auckland, New Zealand.
  macmahon:ctru.auckland.ac.nz
Title
  Effects of lowering average of
  below-average cholesterol levels on the progression of
  carotid atherosclerosis: results of the LIPID Atherosclerosis Substudy. LIPID
  Trial Research Group [published erratum appears in Circulation 1996 Jun
  23;97(24):2479].
Source
  Circulation. 97(18):1784-90, 1998 May 12.
Abstract
  BACKGROUND: Cholesterol lowering in patients with
  above-average cholesterol levels has been shown to reduce
  the progression of atherosclerosis and lower the risk of coronary heart
  disease events. However, there has been uncertainty about the effects of
  cholesterol lowering in patients with
  average or below-average cholesterol
  levels. METHODS AND RESULTS: In this study, 522 patients with a history of
  myocardial infarction or unstable angina and with baseline levels of total
  cholesterol between 4 and 7 mmol/L (mean, 5.7 mmol/L) were randomized to
  treatment with a low fat diet plus pravastatin (40 mg daily) or to a low fat
  diet plus placebo. Treatment with pravastatin reduced the levels of total
  cholesterol by 19%, LDL cholesterol by 27%, apolipoprotein B by 19%, and
  triglycerides by 13% (all 2P<.0001) and increased apolipoprotein A1 and HDL
  cholesterol levels by 4% (both 2P<.0005), in comparison with placebo. Carotid
  atherosclerosis was assessed from B-mode ultrasound measurements of the
  common carotid artery. After 4 years, mean carotid wall thickness had
  increased by 0.048 mm (SE=0.01) in the placebo group and declined by 0.014 mm
  in the pravastatin-treated group (SE=0.01) (2P for difference <.0001). The
  effect of treatment on wall thickness was similar in three groups classified
  by tertiles of total cholesterol at baseline, with mean levels of 4.8, 5.7,
  and 6.6 mmol/L, respectively (2P for interaction >.8). CONCLUSIONS: Treatment
  with pravastatin reduced the development of carotid atherosclerosis among
  patients with coronary heart disease and a wide range of pretreatment
  cholesterol levels. Treatment with this agent prevented any detectable
  increase in carotid wall thickening over 4 years of follow-up.



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