Clinical Investigation

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Marked low-density lipoprotein cholesterol reduction below current national cholesterol education program targets provides the greatest reduction in carotid atherosclerosis

  1. Steven M. Kent M.D.,
  2. Louis C. Coyle D.O.,
  3. Patrick J. Flaherty D.O.,
  4. Thor T. Markwood M.D.,
  5. Allen J. Taylor M.D.*

Article first published online: 5 DEC 2006

DOI: 10.1002/clc.4960270105

Issue

Clinical Cardiology

Clinical Cardiology

Volume 27, Issue 1, pages 17–21, January 2004

Additional Information

How to Cite

Kent, S. M., Coyle, L. C., Flaherty, P. J., Markwood, T. T. and Taylor, A. J. (2004), Marked low-density lipoprotein cholesterol reduction below current national cholesterol education program targets provides the greatest reduction in carotid atherosclerosis. Clin Cardiol, 27: 17–21. doi: 10.1002/clc.4960270105

Author Information

  1. Cardiology Service, Walter Reed Army Medical Center, Washington, D.C., and the Uniformed University of Health Sciences, Bethesda, Maryland, USA

*LTC MC USA Director, Cardiovascular Research Cardiology Service Walter Reed Army Medical Center 6900 Georgia Avenue, NW Building 2, Room 4A Washington, DC 20307-5001, USA

Publication History

  1. Issue published online: 5 DEC 2006
  2. Article first published online: 5 DEC 2006
  3. Manuscript Accepted: 27 DEC 2002
  4. Manuscript Received: 14 AUG 2002

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Abstract

Background: Current National Cholesterol Education Program (NCEP) guidelines recognize low-density lipoprotein cholesterol (LDL-C) below 100 mg/dl as an optimal level. Evidence supporting this is scant. Both LDL-C and C reactive protein (CRP) are known correlates of atherosclerosis progression.

Hypothesis: We examined the effect of final LDL-C and CRP obtained with statin therapy on carotid intima-media thickness (CIMT), a valid surrogate for clinical benefit of lipid-lowering therapies.

Methods: In a randomized, single-center trial, 161 patients were assigned to statin therapy of different potencies (pravastatin 40 mg, n = 82; atorvastatin 80 mg, n=79). The effects on CIMT were assessed in relationship to LDL-C and CRP levels obtained after 12 months of therapy.

Results: Changes in CIMT were directly related to the final LDL-C level obtained on statin therapy after 12 months (R = 0.219, p = 0.015). Carotid intima-media thickness regression was seen in 61% of the subjects in the lowest quartile of final LDL-C (≤ 70 mg/dl) versus 29% of the subjects with the highest quartile of final LDL-C (≥ 114 mg/dl, p = 0.008). No threshold value was seen, with more favorable effects on absolute change in CIMT with lower values of LDL-C (decrease in CIMT of 0.06 ±0.17 mm in the lowest quartile compared with an increase of 0.06 ± 0.09 in the highest quartile of LDL-C, p = 0.008). On-treatment LDL and CRP concentrations both below the group median values were associated with the greatest likelihood of CIMT regression.

Conclusions: Regression of carotid atherosclerosis is directly related to the absolute LDL-C level on statin therapy. The greatest regression was obtained with an LDL-C <70 mg/dl, supporting marked LDL-C reduction to levels below current NCEP guidelines.

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