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(Circulation. 2001;104:2660.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Effect of an Aggressive Lipid-Lowering Strategy on Progression of Atherosclerosis in the Left Main Coronary Artery From Patients in the Post Coronary Artery Bypass Graft Trial

Carl W. White, MD; Fredarick L. Gobel, MD; Lucien Campeau, MD; Genell L. Knatterud, PhD; Sandra A. Forman, MA; James S. Forrester, MD; Nancy L. Geller, PhD; J. Alan Herd, MD; Ann Hickey, MD; Byron J. Hoogwerf, MD; Donald B. Hunninghake, MD; Yves Rosenberg, MD; Michael L. Terrin, MD; , and the Post Coronary Artery Bypass Graft Trial Investigators^*

From the University of Minnesota, Minneapolis (C.W.W., D.B.H.); Minneapolis Heart Institute Foundation, Minneapolis, Minn (F.L.G.); Montreal Heart Institute, Montreal, Quebec, Canada (L.C.); Maryland Medical Research Institute, Baltimore, Md (G.L.K., S.A.F., M.L.T.); Cedars-Sinai Medical Center, Los Angeles, Calif (J.S.F., A.H.); Baylor College of Medicine, Houston, Tex (J.A.H.); Cleveland Clinic Foundation, Cleveland, Ohio (B.J.H.); Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Md (N.L.G.); and Clinical Trials Group, National Heart, Lung, and Blood Institute, Bethesda, Md (Y.R.).

Correspondence to Genell L. Knatterud, PhD, Post CABG Coordinating Center, Maryland Medical Research Institute, 600 Wyndhurst Ave, Baltimore, MD 21210. E-mail gknatterud{at}mmri.org

Background— The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering regimens and low-dose anticoagulation versus placebo on progression of atherosclerosis in saphenous vein grafts of patients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol levels to a mean yearly cholesterol level from 93 to 97 mg/dL compared with a moderate reduction to a level of 132 to 136 mg/dL decreased the progression of atherosclerosis in saphenous vein grafts. Low-dose anticoagulation did not affect progression. This secondary analysis tested the hypothesis that a similar decrease in progression of atherosclerosis would also be present in native coronary arteries as measured in the left main coronary artery (LMCA).

Methods and Results— A sample of 402 patients was randomly selected from 1102 patients who had baseline and follow-up views of the LMCA suitable for analysis. Patients treated with the aggressive lipid-lowering strategy had less progression of atherosclerosis in the LMCA as measured by changes in minimum (P=0.0003) lumen diameter or the maximum percent stenosis (P=0.001), or the presence of substantial progression (P=0.008), or vascular occlusion (P=0.005) when compared with the moderate strategy.

Conclusions— A strategy of aggressive lipid lowering results in significantly less atherosclerosis progression than a moderate approach in LMCAs.

Key Words: coronary disease • lipids • cholesterol • angiography

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