Abstract 76: Relationship between Lipid Reduction and Progression of Coronary Atherosclerosis in Chinese Patients with Established Coronary Artery Disease

Abstract

Background: The current National Heart, Lung, and Blood Institute’s Adult Treatment Panel (ATP) III Guidelines place high priority on reaching target low-density lipoprotein cholesterol (LDL-C) levels for coronary artery disease (CAD) prevention. However, the percentage reduction in LDL-C in relation to the progression of coronary atherosclerosis in patients with established CAD remains uncertain, especially among Chinese population. Methods: We performed retrospective chart review of 318 statin naïve Chinese patients with established CAD who underwent 2 coronary angiographies at least six months apart. Progression of coronary atherosclerosis was defined as in-stent restenosis, or increasing stenosis of 20% or more than baseline. Results: After a median follow-up of 24 months between coronary angiographies, 147(46.2%) patients developed progressive coronary atherosclerosis. There were no significant differences in baseline total cholesterol (TC), total triglycerides (TG), high-density lipoprotein cholesterol (HDL-C) and LDL-C among patients with and without progression of coronary atherosclerosis. The use of statins, aspirin, clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers were also similar between two groups from baseline to follow-up. However, the mean TC (4.83±1.32 vs. 3.99±0.93 mmol/L), TG (1.83±1.16 vs. 1.79±1.80mmol/L) and LDL-C (3.09±1.15 vs. 2.33±0.77 mmol/L) were significantly higher in patients with progressive disease than those in the stable group (all p value <0.01), although there is no difference in HDL-C (1.04±0.25 vs. 1.02±0.25 mmol/L, p=0.66). After multivariate adjustment accounting for age, gender, smoking, number of diseased vessels, stent implantation, serum LDL-C level and LDL-C reduction, achieving LDL-C reduction of 50% or more showed significantly reduced progression of coronary atherosclerosis (Odds ratio [OR] 0.24, 95% confidence interval [CI], 0.06-0.91, p<.05). Other risk factors associated with coronary atherosclerosis progression include heavy smoking (20 cigarettes per day for a minimum of 30 years, OR, 3.88, 95CI, 1.56-9.66. p=.003), the level of LDL-C (≥3.0mmol/l,OR, 4.03, 95CI, 1.79-9.09. p<.001) and number of diseased vessels at baseline (OR, 3.94, 95CI, 1.98-7.84. p<.001). Conclusions: The current study suggests that the benefit of lipid-lowering therapy in progression of coronary atherosclerosis is in proportion to the reduction in LDL-C. Patients with established coronary artery disease may benefit from intensive LDL-C lowering therapy regardless of their baseline LDL-C levels.