REDUCTION IN CAROTID ARTERIAL-WALL THICKNESS USING LOVASTATIN AND DIETARY THERAPY - A RANDOMIZED, CONTROLLED CLINICAL-TRIAL

Objective: To assess the effects of lipid-lowering therapy on the prog ression of early, preintrusive carotid arterial atherosclerosis. Desig n: Randomized, double-blind, placebo-controlled, serial carotid arteri al imaging trial. Setting: University Atherosclerosis Research Unit. P atients: 188 patients from the Monitored Atherosclerosis Regression St udy who were 37 to 67 years of age and had angiographically defined co ronary artery disease. Intervention: Cholesterol-lowering diet plus pl acebo or lovastatin, 80 mg/d. Measurements: High-resolution B-mode ult rasonographic quantification of the combined thickness of the distal c ommon carotid arterial far wall intima-media complex (carotid arterial intima-media thickness) at baseline and every 6 months for as long as 4 years. Results: The annual rate of change in carotid arterial intim a-media thickness differed significantly between the lovastatin group and the placebo group at 2 and 4 years (P < 0.001). Patients receiving lovastatin had consistent reduction of the intima-media thickness (P < 0.001 as early as 1 year), whereas patients receiving placebo had co nsistent increase of the intima-media thickness at 2 and 4 years (P < 0.02). On-trial levels of low-density lipoprotein cholesterol, triglyc erides, and apolipoproteins B, C-III, and E correlated significantly w ith the annual rate of change in carotid arterial intima-media thickne ss (P < 0.001). Conclusion: Lipid-lowering therapy reverses the progre ssion of early, preintrusive atherosclerosis of the carotid artery. Bo th cholesterol-rich and triglyceride-rich lipoproteins correlate with the progression of early, pre-intrusive atherosclerosis of the carotid artery. These findings, together with earlier reports of the effects of lovastatin therapy on the progression of atherosclerosis of the cor onary arteries, indicate that carotid arterial far wall intima-media t hickness is a useful end point for anti-atherosclerosis trials.