The benefit of aggressive lipid lowering

The beneficial effects of lipid-lowering therapy for the primary and second ary prevention of coronary heart disease (CHD) have been conclusively demon strated in large-scale clinical trials. Does more aggressive lipid lowering provide even greater clinical benefit? The post coronary artery bypass gra ft (post-CABG) study was the first angiographic trial to show that aggressi ve lipid-lowering therapy was more effective at reducing disease progressio n than conventional approaches to cholesterol management. Recently, the res ults of the atorvastatin versus revascularization treatments (AVERT) trial have also shown significant benefit on clinical events with aggressive lipi d lowering. A total of 341 patients with stable CHD were randomly assigned to receive medical therapy with atorvastatin 80 mg/day plus conventional tr eatment or angioplasty followed by usual care. Atorvastatin therapy resulte d in a 46% reduction in the mean low-density lipoprotein cholesterol level compared with an 18% decrease for patients in the angioplasty/usual care gr oup. Patients treated with atorvastatin had fewer ischemic events compared with those who had angioplasty (13 vs. 21%. P = 0.018) and a significantly greater time to first ischemic event (P = 0.027). AVERT is the first clinic al study demonstrating that patients with stable CHD achieve significant ca rdiovascular benefit by aggressively lowering cholesterol levels with atorv astatin. It would therefore appear that an aggressive approach to lipid-low ering therapy is beneficial in patients with existing CHD. (C) 2000 Elsevie r Science Ireland Ltd. All rights reserved.