Abstract
BACKGROUND-: Recent clinical trials have suggested that intensive versus standard lipid-lowering therapy provides for additional benefit. Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification (CAC) in serial measurements. METHODS AND RESULTS-: In a multicenter, randomized, double-blind trial, 471 patients (age 61±8 years) who had no history of coronary artery disease and no evidence of high-grade coronary stenoses (>50% diameter reduction) were randomized if they had ≥2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidenced by a CAC score ≥30. Patients were assigned to receive 80 mg or 10 mg of atorvastatin per day over 12 months. Progression of CAC volume scores could be analyzed in 366 patients. After pretreatment with 10 mg of atorvastatin for 4 weeks, 12 months of study medication reduced LDL cholesterol from 106±22 to 87±33 mg/dL in the group randomized to receive 80 mg of atorvastatin (P<0.001), whereas levels remained stable in the group randomized to receive 10 mg (108±23 at baseline, 109±28 mg/dL at the end of the study, P=NS). The mean progression of CAC volume scores, corrected for the baseline CAC volume score, was 27% (95% CI 20.8% to 33.1%) in the 80-mg atorvastatin group and 25% (95% CI 19.1% to 30.8%) in the 10-mg atorvastatin group (P=0.65). CAC progression showed no relationship with on-treatment LDL cholesterol levels. CONCLUSIONS-: We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis. Over a period of 12 months, intensive atorvastatin therapy was unable to attenuate CAC progression compared with standard atorvastatin therapy. The possibility remains that the time window was too short to demonstrate an effect.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 427-437 |
| Number of pages | 11 |
| Journal | Circulation |
| Volume | 113 |
| Issue number | 3 |
| DOIs | |
| State | Published - Jan 2006 |
| Externally published | Yes |
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Keywords
- Atherosclerosis
- Cholesterol
- Drugs
- Hypercholesterolemia
ASJC Scopus subject areas
- Physiology
- Cardiology and Cardiovascular Medicine
Cite this
Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months : A multicenter, randomized, double-blind trial. / Schmermund, Axel; Achenbach, Stephan; Budde, Thomas; Buziashvili, Yuri; Förster, Andreas; Friedrich, Guy; Henein, Michael; Kerkhoff, Gert; Knollmann, Friedrich D; Kukharchuk, Valery; Lahiri, Avijit; Leischik, Roman; Moshage, Werner; Schartl, Michael; Siffert, Winfried; Steinhagen-Thiessen, Elisabeth; Sinitsyn, Valentin; Vogt, Anja; Wiedeking, Burkhard; Erbel, Raimund.
In: Circulation, Vol. 113, No. 3, 01.2006, p. 427-437.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months
T2 - A multicenter, randomized, double-blind trial
AU - Schmermund, Axel
AU - Achenbach, Stephan
AU - Budde, Thomas
AU - Buziashvili, Yuri
AU - Förster, Andreas
AU - Friedrich, Guy
AU - Henein, Michael
AU - Kerkhoff, Gert
AU - Knollmann, Friedrich D
AU - Kukharchuk, Valery
AU - Lahiri, Avijit
AU - Leischik, Roman
AU - Moshage, Werner
AU - Schartl, Michael
AU - Siffert, Winfried
AU - Steinhagen-Thiessen, Elisabeth
AU - Sinitsyn, Valentin
AU - Vogt, Anja
AU - Wiedeking, Burkhard
AU - Erbel, Raimund
PY - 2006/1
Y1 - 2006/1
N2 - BACKGROUND-: Recent clinical trials have suggested that intensive versus standard lipid-lowering therapy provides for additional benefit. Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification (CAC) in serial measurements. METHODS AND RESULTS-: In a multicenter, randomized, double-blind trial, 471 patients (age 61±8 years) who had no history of coronary artery disease and no evidence of high-grade coronary stenoses (>50% diameter reduction) were randomized if they had ≥2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidenced by a CAC score ≥30. Patients were assigned to receive 80 mg or 10 mg of atorvastatin per day over 12 months. Progression of CAC volume scores could be analyzed in 366 patients. After pretreatment with 10 mg of atorvastatin for 4 weeks, 12 months of study medication reduced LDL cholesterol from 106±22 to 87±33 mg/dL in the group randomized to receive 80 mg of atorvastatin (P<0.001), whereas levels remained stable in the group randomized to receive 10 mg (108±23 at baseline, 109±28 mg/dL at the end of the study, P=NS). The mean progression of CAC volume scores, corrected for the baseline CAC volume score, was 27% (95% CI 20.8% to 33.1%) in the 80-mg atorvastatin group and 25% (95% CI 19.1% to 30.8%) in the 10-mg atorvastatin group (P=0.65). CAC progression showed no relationship with on-treatment LDL cholesterol levels. CONCLUSIONS-: We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis. Over a period of 12 months, intensive atorvastatin therapy was unable to attenuate CAC progression compared with standard atorvastatin therapy. The possibility remains that the time window was too short to demonstrate an effect.
AB - BACKGROUND-: Recent clinical trials have suggested that intensive versus standard lipid-lowering therapy provides for additional benefit. Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification (CAC) in serial measurements. METHODS AND RESULTS-: In a multicenter, randomized, double-blind trial, 471 patients (age 61±8 years) who had no history of coronary artery disease and no evidence of high-grade coronary stenoses (>50% diameter reduction) were randomized if they had ≥2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidenced by a CAC score ≥30. Patients were assigned to receive 80 mg or 10 mg of atorvastatin per day over 12 months. Progression of CAC volume scores could be analyzed in 366 patients. After pretreatment with 10 mg of atorvastatin for 4 weeks, 12 months of study medication reduced LDL cholesterol from 106±22 to 87±33 mg/dL in the group randomized to receive 80 mg of atorvastatin (P<0.001), whereas levels remained stable in the group randomized to receive 10 mg (108±23 at baseline, 109±28 mg/dL at the end of the study, P=NS). The mean progression of CAC volume scores, corrected for the baseline CAC volume score, was 27% (95% CI 20.8% to 33.1%) in the 80-mg atorvastatin group and 25% (95% CI 19.1% to 30.8%) in the 10-mg atorvastatin group (P=0.65). CAC progression showed no relationship with on-treatment LDL cholesterol levels. CONCLUSIONS-: We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis. Over a period of 12 months, intensive atorvastatin therapy was unable to attenuate CAC progression compared with standard atorvastatin therapy. The possibility remains that the time window was too short to demonstrate an effect.
KW - Atherosclerosis
KW - Cholesterol
KW - Drugs
KW - Hypercholesterolemia
UR - http://www.scopus.com/inward/record.url?scp=33644866420&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33644866420&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.105.568147
DO - 10.1161/CIRCULATIONAHA.105.568147
M3 - Article
C2 - 16415377
AN - SCOPUS:33644866420
VL - 113
SP - 427
EP - 437
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 3
ER -