Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): Reduction in atherosclerosis progression and clinical events

Abstract

In patients with coronary artery disease and mild to moderate cholesterol elevations, pravastatin reduces progression of coronary atherosclerosis and myocardial infarction. The time course of event reduction increases the potential for a relatively rapid decrease in the clinical manifestations of coronary artery disease with lipid lowering.

Hyperlipidemia Promotes Thrombosis After Injury to Atherosclerotic Vessels in Apolipoprotein E–Deficient Mice

“…[13][14][15][16] This salutary effect is observed soon after the onset of treatment and despite the minimal effects of lipid lowering on the size of the atherosclerotic lesion. 2,17 Thus, acute changes in lipids appear to have significant effects on factors influencing acute thrombosis in the setting of atherosclerosis.…”

“…1 Elevated cholesterol levels increase the risk of arterial thrombotic events in patients with atherosclerosis, and cholesterollowering therapy reduces the risk of myocardial infarction and stroke to an extent that is out of proportion to the reduction in plaque size. 2 Alterations in lipid levels have been proposed to influence thrombosis by modifying the activity of coagulation proteins, 3,4 platelets, 5 and fibrinolytic factors. 6,7 However, the effect of acute high fat feeding-induced hypercholesterolemia on the development of occlusive thrombosis after injury to an atherosclerotic artery has not been extensively analyzed.…”

Statins and total (not LDL) cholesterol concentration and outcome of myocardial infarction: results from a meta-analysis and an observational study

“…In the 14 secondary prevention studies, patients were randomised to statin treatment or placebo: pravastatin (7 trials and 15,769 participants) [5,8,[15][16][17][18][19], simvastatin (3 trials and 5,825 participants) [20][21][22], lovastatin (2 trials and 601 participants) [23,24], and fluvastatin (2 trials and 794 participants) [25,26]. The lipid concentrations in both groups were measured and reported in all trials at baseline and the end of follow-up.…”

Métodos por imagem da aterosclerose em estudos de progressão/regressão: marcador substituto ou janela direta para o processo patológico da aterosclerose?

“…Based on extensive data from various patient populations, it is well established that angiographically determined disease progression reflects clinical prognosis 9,10 . Results from serial angiographic multicenter trials during lipid-modifying treatment demonstrate that change in luminal stenosis is a valid surrogate marker for cardiovascular risk [11][12][13][14][15] . This experience is summarized in a meta-analysis of QCA studies describing data of a total of 3674 patients with coronary disease who were treated with different drug classes 16,17 .…”