Effect of an aggressive lipid-lowering strategy on progression of atherosclerosis in the left main coronary artery from patients in the Post CoronaryArtery Bypass Graft Trial

Background-The Post Coronary Artery Bypass Graft Trial, designed to compare the effects of two lipid-lowering re-imens and low-dose anticoaculation ve rsus lacebo on progression of atherosclerosis in saphenous vein grafts of p atients who had had CABG surgery, demonstrated that aggressive lowering of LDL cholesterol levels to a mean yearly cholesterol level from 93 to 97 mg/ dL compared with a moderate reduction to a level of 132 to 136 mg/dL decrea sed the progression of atherosclerosis in saphenous vein grafts. Low-dose a nticoagulation did not affect progression. This secondary analysis tested t he hypothesis that a similar decrease in progression of atherosclerosis wou ld also be present in native coronary arteries as measured in the left main coronary artery (LMCA). Methods and Results-A sample of 402 patients was randomly selected from 110 2 patients who had baseline and follow-up views of the LMCA suitable for an alysis. Patients treated with the aggressive lipid-lowering strategy had le ss progression of atherosclerosis in the LMCA as measured by changes in min imum (P=0.0003) lumen diameter or the maximum percent stenosis (P=0.001), o r the presence of substantial progression (P=0.008), or vascular occlusion (P=0.005) when compared with the moderate strategy. Conclusions-A strategy of aggressive lipid lowering results in significantl y less atherosclerosis progression than a moderate approach in LMCAs.