For Reducing Atherosclerosis, Is Aggressive Tx More Beneficial?
According to a new study presented at the Society for Cardiovascular Angiography and Interventions 2015 Scientific Sessions, treating both low-density lipoprotein cholesterol (LDL-C) with statins and blood pressure (BP) with calcium channel blockers reduces harmful coronary plaque. The MILLION study is the first multicenter study to evaluate whether combined therapy with aggressive or standard targets for reducing LDL-C and BP would provide additional benefits.
Researchers evaluated treatment in a total of 68 patients, including 33 patients who received standard therapy (LDL to 100mg/dL; BP <140/90mmHg) and 35 patients treated with aggressive therapy (LDL to 70mg/dL; BP to 120/70mmHg). Prior to the study, all of the patients were treated successfully with percutaneous coronary intervention (PCI), had LDL levels >100mg/dL and had at least one additional coronary artery blockage in addition to the blockage treated by PCI.
Each patient underwent intravascular ultrasonography (IVUS) to measure vessel and plaque volume. After 18-24 months of treatment with BP and cholesterol-lowering medications, follow-up IVUS was conducted. Patients in both groups reached their target BP and LDL levels at the time of follow-up.
The study found both groups had similar rates of reduction in coronary plaque volume. The standard treatment group saw coronary plaque reduced by 9.37% while the aggressive group saw an 8.74% decrease, on average. However, patients treated with aggressive medication therapy saw more significant decreases in BP (7.5/9.5mmHg decrease) and LDL-C (6.1mg/dL decrease) compared with patients receiving standard treatment.
The investigators concluded that aggressive medication therapy did not provide additional benefit compared to standard cholesterol and BP-lowering therapy.
"Patients benefit from similar levels of coronary plaque volume reduction with the standard therapy as with more aggressive treatment," said Masa-aki Kawashiri, MD, associate professor of medicine in the Division of Cardiovascular Medicine at Kanazawa University in Kanazawa, Japan, and a study investigator. "Aggressive LDL cholesterol and blood pressure medication treatment does not provide additional benefit in reducing atherosclerosis. Combined therapy aimed at standard LDL and blood pressure targets provides similar benefit as more aggressive treatment."