The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0±9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18-24months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100mg/dL and 140/90mmHg vs. 70mg/dL and 120/70mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9±14.7 vs. 63.7±11.9mg/dL (NS) and 124.1±9.4/75.8±7.7 vs. 113.6±9.6/65.8±9.4mmHg (systolic BP; NS, diastolic BP; p<0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of -9.4±10.7% and -8.7±8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.