Aggressive Lipid-Lowering Therapy Compared with Angioplasty in Stable Coronary Artery Disease

Pitt, Bertram; Waters, David D.; Brown, W. Virgil; Boven, Ad J. van; Schwartz, Lisa M.; Title, Lawrence M.; Eisenberg, Daniel A.; Shurzinske, Linda; McCormick, L.

doi:10.1056/nejm199907083410202

Cited by 816 publications

(354 citation statements)

References 11 publications

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“…Statin-treated persons showed decreased macrophages, T-cells, and apoptotic cells in atherosclerotic plaques, with a linear relationship between the degree of LDL lowering and the reduction in risk of CVD events that was shown recently in a report in which fluvastatin decreased death and myocardial infarction by 58%, with particular benefit in persons with diabetes (39). In another study, atorvastatin 80 mg daily without angioplasty decreased LDL cholesterol to 77 mg/dl, with 13% 18-month risk of ischemic events, in comparison to an ischemic event rate of 21% among persons undergoing angioplasty with mean LDL cholesterol 119 mg/dl (40). Selwyn noted, however, that too often physicians do not administer statins "with any vigor at all, despite evidence that those persons given such treatment have improved outcome.…”

Section: Studies In Manmentioning

confidence: 85%

Inflammation and Insulin Resistance

Bloomgarden¹

2003

Diabetes Care

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Section: Studies In Manmentioning

confidence: 85%

Inflammation and Insulin Resistance

Bloomgarden¹

2003

Diabetes Care

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“…Recent studies have suggested that in low-risk patients with stable coronary artery disease, aggressive lipid lowering therapy might be at least as effective as angioplasty in reducing the incidence of ischemic events, emphasizing the importance of treating risk factors. [23][24][25] We have no comparative group of patients with stable angina pectoris who were not referred for catheterization. Thus, we cannot exclude the possibility that patients not undergoing invasive investigations might receive a more appropriate medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Medical treatment of patients with stable angina pectoris referred for coronary angiography: Failure of treatment or failure to treat

Carasso¹,

Markiewicz²

2002

Clinical Cardiology

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SummaryBackground: Patients referred for elective coronary arteriography because of stable angina pectoris frequently do not receive appropriate medical therapy prior to arteriography. Persistence of symptoms due to lack of appropriate therapy may influence the decision to catheterize and the treatment chosen following catheterization.Hypothesis: The present study evaluates whether patients with stable angina pectoris referred for cardiac catheterization received optimal therapy prior to the procedure. We also evaluated whether medical therapy was optimized as a result of the hospitalization for catheterization.Methods: We evaluated prospectively the adequacy of medical therapy in 333 consecutive patients undergoing elective coronary arteriography. Of these, 160 had stable angina pectoris as their main problem and constituted the study group.Results: Mean duration of angina was 7.5 ± 6.3 months. Canadian Cardiovascular Society angina grade 1 was present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography showed a ≥ 50% coronary stenosis in 141 of 160 patients. Aspirin was used by 96%, and 86% received at least one drug aimed at relieving anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and long-acting nitrates in 29%. Antianginal drugs and drugs aimed at treating risk factors were usually taken at a low, subtherapeutic dosage. Only 35 of 110 patients taking beta blockers had a resting heart rate of ≤ 60/min. Following catheterization, 88 of 141 patients with coronary stenosis of ≥ 50% underwent percutanous intervention and 5 had urgent surgery. Optimization of treatment was advised in only 7 of 48 patients for whom medical therapy or elective surgery was recommended.Conclusion: Patients with stable angina pectoris are frequently referred for cardiac catheterization without making a serious attempt to control their symptoms by medical therapy.

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“…Contrary to past management, when PCI and medical therapy had been considered as alternate, competing strategies for symptomatic CAD (18,19), lipid-lowering therapy is now seen as providing early, complementary benefit in combination with coronary revascularization. However, in a recent survey, only 26.5% of 5052 patients undergoing PCI were receiving statin treatment at the time of the procedure (10).…”

Section: Methods: Patients Undergoing a First Pci Between August 2000mentioning

confidence: 99%

The use of lipid-lowering therapy for secondary prevention in patients undergoing percutaneous coronary intervention

Jessica

Jackevicius

Genus

et al. 2006

Canadian Journal of Cardiology

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Aggressive Lipid-Lowering Therapy Compared with Angioplasty in Stable Coronary Artery Disease

Abstract: In low-risk patients with stable coronary artery disease, aggressive lipid-lowering therapy is at least as effective as angioplasty and usual care in reducing the incidence of ischemic events.

Cited by 816 publications

References 11 publications

Inflammation and Insulin Resistance

Inflammation and Insulin Resistance

Medical treatment of patients with stable angina pectoris referred for coronary angiography: Failure of treatment or failure to treat

The use of lipid-lowering therapy for secondary prevention in patients undergoing percutaneous coronary intervention

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