Title

Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease .

Purpose

To compare percutaneous coronary revascularisation with lipid-lowering treatment for reducing the incidence of ischemic events.

Design

Randomized, multicenter .

Patients

341 patients with stable coronary artery disease, relatively normal left ventricular function, asymptomatic or mild-to-moderate angina, a serum level of LDL cholesterol of at least 115 mg/dl and stenosis of 50% or more in at least one coronary artery and referred for percutaneous revascularisation .

Follow-up
18 months

Treatment regimen

Atorvastatin 80 mg daily vs. percutaneous revascularisation procedure (angioplasty), followed by usual care, which could include lipid-lowering treatment.

Additional therapy

Patients assigned to angioplasty and usual care were allowed to continue their current drug regimen .

Results

• LDL cholesterol reduced by 46% in the atorvastatin group compared to an 18% reduction in the angioplasty group.
Total cholesterol reduced by 31% and 10% in the atorvastatin and angioplasty group, respectively. Triglycerides
reduced by 11% in the atorvastatin group but increased by 10% in the angioplasty group.
• Incidence of ischemic events was 36% lower in the atorvastatin group as compared to the angioplasty group.
• As compared to patients who were treated with angioplasty and usual care, the patients who received atorvastatin had a
significantly longer time to the first ischemic event .

Conclusion

In low-risk patients with stable coronary artery disease, aggressive lipid-lowring therapy ia at least as effective as angioplasty and usual care in reducing the incidence of ischemic events.