Effect of Intensive Compared With Moderate Lipid-Lowering Therapy on Progression of Coronary Atherosclerosis

Abstract

In a series of pivotal clinical trials, statin drugs have been shown to reduce both atherogenic lipoproteins and cardiovascular morbidity and mortality.^1-5 However, the optimal approach to lipid reduction with statins in patients with established coronary artery disease (CAD) remains uncertain. Although the efficacy of the various statins in reducing atherogenic lipoproteins and vascular inflammation varies significantly,⁶ the impact of these differences on clinical outcome is unknown. Because the large trials assessing morbidity and mortality were placebo controlled, they provide limited insight into differences between alternative strategies and target levels for lipid reduction. Accordingly, there is little scientific basis for recommending treatment to reduce low-density lipoprotein cholesterol (LDL-C) levels below the current recommended guidelines.^7,8