Regression and Decrease in Progression of Coronary Artery Disease Through Lipid-Lowering Therapy

Abstract

Today there exists a sequence of variously designed studies in which the effect of lipid-lowering intervention on serial angiographies of the coronary arteries and other vessels has been investigated. The aim of our own prospective intervention study was to examine the effect of fenofibrate on the progress of minor coronary narrowings in hypercholesterolemic patients. We compared the angiographic follow-up (average angiographic interval: 21 ± 6 months) of an intervention group treated with 200-400 mg/day of fenofibrate (21 patients, 98 narrowings) with those of an untreated comparison group (21 patients, 93 narrowings) by means of quantitative coronary angiography with computer-assisted contour detection. The low density lipoprotein-cholesterol (LDL) levels of the intervention group (checked every six weeks) were lowered from 229 ± 30 mg/dl by an average of 19.5%, while those of the comparison group were 241 ± 53 mg/dl and remained almost completely unchanged. The distribution of the parameter “Change in Percent Plaque Area” (%PA-change) (classified in patient-related regressions, stillstands and progressions on the basis of the reproducibility of the measuring method) shifted significantly toward regressions (p=0.032) in the intervention group: 33% progressions (comparison group: 67%), 48% stillstands (comparison group: 33%), 19% regressions (comparison group: 0%). The changes in percent diameter reduction and percent plaque area correlated positively to mean intervention cholesterol and LDL levels.

The results indicate the beneficial effect of fenofibrate on minor coronary narrowings, and correspond to the other angiographically controlled lipid-lowering intervention studies which show the benefit of lipid therapy, particularly the lowering of elevated LDL levels in secondary prevention of coronary artery disease.