PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmjcredLink to Publisher's site
 
Br Med J (Clin Res Ed). 1984 July 28; 289(6439): 220–223.
PMCID: PMC1442285

Prevention of progression of coronary atherosclerosis by treatment of hyperlipidaemia: a seven year prospective angiographic study.

Abstract

The progression of coronary atherosclerosis was assessed by repeat angiography in 28 patients and 20 controls with hyperlipidaemia (serum cholesterol concentration greater than 7.2 mmol/l (278 mg/100 ml) or serum triglyceride concentration greater than 2.0 mmol/l (177 mg/100 ml), or both) and symptomatic coronary artery disease of two or three vessels. Twenty eight patients (26 men and two women) were treated with diet and drugs (clofibrate or nicotinic acid, or both) to lower lipid concentrations. Twenty men taking part in a simultaneous study served as non-randomised controls. They received medical treatment for coronary artery disease but no treatment to reduce lipid concentrations. The initial levels of coronary risk factors and the angiographic state were comparable in the two groups. In the 28 patients total cholesterol, total triglyceride, and low density lipoprotein cholesterol concentrations were reduced by an average 18%, 38%, and 19% respectively by treatment for hyperlipidaemia and high density lipoprotein cholesterol concentration was increased on average by 10%. The treatment maintained these concentrations during a follow up of seven years. By all criteria coronary lesions progressed significantly less in the patients than the controls: the angiographic state remained completely unchanged in nine (32%) of the patients compared with only one (8%) of the surviving controls; of the arterial segments at risk, 46 (16.5%) progressed in the patients compared with 50 (38.2%) in the controls (p less than 0.001); and the coronary obstruction increased less in patients than in controls (p less than 0.05). Cardiac survival was 89% in seven years in the patients compared with 65% in five years in the controls (p less than 0.01). The anginal symptoms diminished or remained stable in 16 of the 24 patients who survived until the end of the study. The progression of coronary atheromatosis was significantly greater in those patients who during the seven years of treatment had an average total cholesterol concentration, VLDL plus LDL cholesterol concentration, or ratio of LDL to HDL cholesterol concentration above the respective median value than in those with the corresponding values below median. On the other hand, the patients with HDL cholesterol concentrations above the median during treatment showed less progression than those with lower HDL cholesterol concentrations. The increase in coronary obstruction was inversely related to the average HDL cholesterol concentration during treatment. The progression was not, however, related to LDL cholesterol concentration during treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1007K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Gresham GA. Is atheroma a reversible lesion? Atherosclerosis. 1976 May-Jun;23(3):379–391. [PubMed]
  • Stary HC. Regression of atherosclerosis in primates. Virchows Arch A Pathol Anat Histol. 1979 Jul 31;383(2):117–134. [PubMed]
  • Miettinen M, Turpeinen O, Karvonen MJ, Elosuo R, Paavilainen E. Effect of cholesterol-lowering diet on mortality from coronary heart-disease and other causes. A twelve-year clinical trial in men and women. Lancet. 1972 Oct 21;2(7782):835–838. [PubMed]
  • Rosenhamer G, Carlson LA. Effect of combined clofibrate--nicotinic acid treatment in ischemic heart disease. Atherosclerosis. 1980 Sep;37(1):129–142. [PubMed]
  • Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981 Dec 12;2(8259):1303–1310. [PubMed]
  • May GS, Eberlein KA, Furberg CD, Passamani ER, DeMets DL. Secondary prevention after myocardial infarction: a review of long-term trials. Prog Cardiovasc Dis. 1982 Jan-Feb;24(4):331–352. [PubMed]
  • Blankenhorn DH, Brooks SH, Selzer RH, Barndt R., Jr The rate of atherosclerosis change during treatment of hyperlipoproteinemia. Circulation. 1978 Feb;57(2):355–361. [PubMed]
  • Malinow MR. Regression of atherosclerosis in humans: fact or myth? Circulation. 1981 Jul;64(1):1–3. [PubMed]
  • Duffield RG, Lewis B, Miller NE, Jamieson CW, Brunt JN, Colchester AC. Treatment of hyperlipidaemia retards progression of symptomatic femoral atherosclerosis. A randomised controlled trial. Lancet. 1983 Sep 17;2(8351):639–642. [PubMed]
  • Buchwald H, Moore RB, Rucker RD, Jr, Amplatz K, Castaneda WR, Francoz RA, Pasternak RC, Varco RL. Clinical angiographic regression of atherosclerosis after partial ileal bypass. Atherosclerosis. 1983 Jan;46(1):117–128. [PubMed]
  • Thompson GR, Myant NB, Kilpatrick D, Oakley CM, Raphael MJ, Steiner RE. Assessment of long-term plasma exchange for familial hypercholesterolaemia. Br Heart J. 1980 Jun;43(6):680–688. [PMC free article] [PubMed]
  • Kuo PT, Hayase K, Kostis JB, Moreyra AE. Use of combined diet and colestipol in long-term (7--7 1/2 years) treatment of patients with type II hyperlipoproteinemia. Circulation. 1979 Feb;59(2):199–211. [PubMed]
  • Brensike JF, Levy RI, Kelsey SF, Passamani ER, Richardson JM, Loh IK, Stone NJ, Aldrich RF, Battaglini JW, Moriarty DJ, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II Coronary Intervention Study. Circulation. 1984 Feb;69(2):313–324. [PubMed]
  • Frick MH, Valle M, Harjola PT. Progression of coronary artery disease in randomized medical and surgical patients over a 5-year angiographic follow-up. Am J Cardiol. 1983 Oct 1;52(7):681–685. [PubMed]
  • Frick MH, Valle M, Harjola PT, Korhola O. Changes in native coronary arteries after coronary bypass surgery. Role of graft patency, serum lipids and hypertension. Am J Cardiol. 1975 Nov;36(6):744–750. [PubMed]
  • Bruschke AV, Wijers TS, Kolsters W, Landmann J. The anatomic evolution of coronary artery disease demonstrated by coronary arteriography in 256 nonoperated patients. Circulation. 1981 Mar;63(3):527–536. [PubMed]
  • HAVEL RJ, EDER HA, BRAGDON JH. The distribution and chemical composition of ultracentrifugally separated lipoproteins in human serum. J Clin Invest. 1955 Sep;34(9):1345–1353. [PMC free article] [PubMed]
  • Proudfit WJ, Bruschke AV, MacMillan JP, Williams GW, Sones FM., Jr Fifteen year survival study of patients with obstructive coronary artery disease. Circulation. 1983 Nov;68(5):986–997. [PubMed]
  • Brown BG, Bolson EL, Dodge HT. Arteriographic assessment of coronary atherosclerosis. Review of current methods, their limitations, and clinical applications. Arteriosclerosis. 1982 Jan-Feb;2(1):2–15. [PubMed]
  • Olsson AG, Carlson LA, Erikson U, Hemius G, Hemmingsson A, Ruhn G. Regression of computer estimated femoral atherosclerosis after pronounced serum lipid lowering in patients with asymptomatic hyperlipidaemia. Lancet. 1982 Jun 5;1(8284):1311–1311. [PubMed]
  • Oliver MF. Serum cholesterol--the knave of hearts and the joker. Lancet. 1981 Nov 14;2(8255):1090–1095. [PubMed]

Articles from British Medical Journal (Clinical Research Ed.) are provided here courtesy of BMJ Publishing Group