Beneficial effects of pravastatin (± colestyramine/niacin) initiated immediately after a coronary event (the randomized lipid-coronary artery disease [L-CAD] study)

Secondary prevention of coronary heart disease by antilipidemic therapy beginning at ≥3 months after an acute coronary syndrome is well documented. The impact, however, of immediate initiation of antilipidemic therapy on coronary stenoses and clinical outcome in patients with acute coronary syndrome...

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Bibliographic Details
Published in:The American journal of cardiology 2000-12, Vol.86 (12), p.1293-1298
Main Authors: Arntz, Hans-Richard, Agrawal, Rahul, Wunderlich, Werner, Schnitzer, Luise, Stern, Richard, Fischer, Frank, Schultheiss, Heinz-Peter
Format: Article
Language:English
Subjects:
Adult
Aged
Angina, Unstable - therapy
Angioplasty, Balloon, Coronary
Anticholesteremic Agents - administration & dosage
Anticholesteremic Agents - therapeutic use
Biological and medical sciences
Chemoprevention
Chi-Square Distribution
Cholesterol, LDL - blood
Cholestyramine Resin - administration & dosage
Cholestyramine Resin - therapeutic use
Confidence Intervals
Coronary Angiography
Coronary Artery Disease - pathology
Coronary Artery Disease - prevention & control
Coronary Disease - pathology
Coronary Disease - prevention & control
Coronary Vessels - drug effects
Coronary Vessels - pathology
Drug Combinations
Female
Follow-Up Studies
General and cellular metabolism. Vitamins
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Medical sciences
Middle Aged
Myocardial Infarction - etiology
Myocardial Infarction - physiopathology
Niacin - administration & dosage
Niacin - therapeutic use
Odds Ratio
Peripheral Vascular Diseases - etiology
Pharmacology. Drug treatments
Pravastatin - administration & dosage
Pravastatin - therapeutic use
Regression Analysis
Statistics, Nonparametric
Stroke - etiology
Survival Rate
Treatment Outcome
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Summary:Secondary prevention of coronary heart disease by antilipidemic therapy beginning at ≥3 months after an acute coronary syndrome is well documented. The impact, however, of immediate initiation of antilipidemic therapy on coronary stenoses and clinical outcome in patients with acute coronary syndrome is unknown. In our study, patients were randomized, on average, 6 days after an acute myocardial infarction and/or percutaneous transluminal coronary angioplasty secondary to unstable angina, to pravastatin (combined, when necessary, with cholestyramine and/or nicotinic acid) to achieve low-density lipoprotein cholesterol levels of ≤130 mg/dl (group A, n = 70). In controls (group B, n = 56), antilipidemic therapy was determined by family physicians. Quantitative coronary angiography was performed at inclusion, and at 6- and 24-month follow-up. The combined clinical end points were total mortality, cardiovascular death, nonfatal myocardial infarction, need for coronary intervention, stroke, and new onset of peripheral vascular disease. Minimal lumen diameter in group A increased by 0.05 ± 0.20 mm after 6 months and 0.13 ± 0.29 mm after 24 months, whereas it decreased by 0.08 ± 0.20 mm and 0.18 ± 0.27 mm, respectively, in group B (p = 0.004 at 6 months and p
ISSN:0002-9149
1879-1913
DOI:10.1016/S0002-9149(00)01230-3