When it comes to cholesterol and blood pressure targets, 'close' is not good enough; optimal control of both is best to halt or even reverse coronary plaque progression.
© AFP/File Ferenc IszaMarch 24, 2009, (Sawf News) - When it comes to cholesterol and blood pressure targets, 'close' is not good enough; optimal control of both is best to halt or even reverse coronary plaque progression.
New data published in the March 31, 2009, issue of the Journal of the American College of Cardiology show that patients with coronary artery disease (CAD) who achieve very low levels of low-density lipoprotein (LDL) cholesterol along with normal systolic blood pressure have the slowest progression of CAD. The results suggest that patients with CAD should be treated to the most stringent target levels so that they can achieve optimal results from their lipid lowering and antihypertensive therapies.
"This paper has a simple but important message regarding dual targets for prevention of coronary artery disease," says Adnan K. Chhatriwalla, M.D., interventional cardiology fellow at the Cleveland Clinic, Cleveland, Ohio, and lead author of the study. "It is the first study to demonstrate that normal blood pressure and very low LDL cholesterol in combination are associated with attenuation of the progression of coronary disease in humans. Even though patients may have reasonable control of blood pressure and cholesterol, getting them to optimal treatment goals is best in terms of slowing plaque progression."
Dr. Chhatriwalla and his colleagues studied changes in atheroma burden as monitored by intravascular ultrasound (IVUS) in 3,437 patients with CAD. The patients were stratified based on LDL cholesterol greater or less than 70 mg/dL and systolic blood pressure greater or less than 120 mmHg. Four different measures of plaque progression were studied: Percent atheroma volume, total atheroma volume, percent of patients with significant plaque progression, and percent of patients with significant plaque regression.
For all of those variables, there was less progression of disease in patients who achieved LDL-cholesterol = 70 mg/dL and systolic blood pressure = 120 mmHg in combination.
"The finding that patients who were able to get their LDL below 70 mg/dL and their systolic blood pressure below 120 mmHg had the slowest progression of heart disease supports the growing concept that more than one risk factor is driving the disease," says Stephen J. Nicholls, assistant professor of molecular medicine at the Cleveland Clinic, and co-author of the study. "The thought really needs to be that the greatest bang for your buck in terms of preventing heart disease is going to be by trying to have aggressive control of all the risk factors."
Dr. Chhatriwalla maintains his study sends an important message. "This study suggests that when it comes to cholesterol and blood pressure targets, 'close' is not good enough. We need to stress that patients with the best risk factor control have the best clinical results. This is the take-home message."
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