Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Combination of very low LDL and normal systolic blood pressure attenuate coronary artery disease

25.03.2009
Moderately good control of LDL-C and systolic BP is not enough; optimal control of both is best to halt or even reverse coronary plaque progression

New data published in the March 31, 2009, issue of the Journal of the American College of Cardiology show that patients with coronary artery disease (CAD) who achieve very low levels of low-density lipoprotein (LDL) cholesterol along with normal systolic blood pressure have the slowest progression of CAD.

The results suggest that patients with CAD should be treated to the most stringent target levels so that they can achieve optimal results from their lipid lowering and antihypertensive therapies.

"This paper has a simple but important message regarding dual targets for prevention of coronary artery disease," says Adnan K. Chhatriwalla, M.D., interventional cardiology fellow at the Cleveland Clinic, Cleveland, Ohio, and lead author of the study. "It is the first study to demonstrate that normal blood pressure and very low LDL cholesterol in combination are associated with attenuation of the progression of coronary disease in humans. Even though patients may have reasonable control of blood pressure and cholesterol, getting them to optimal treatment goals is best in terms of slowing plaque progression."

Dr. Chhatriwalla and his colleagues studied changes in atheroma burden as monitored by intravascular ultrasound (IVUS) in 3,437 patients with CAD. The patients were stratified based on LDL cholesterol greater or less than 70 mg/dL and systolic blood pressure greater or less than 120 mmHg. Four different measures of plaque progression were studied: Percent atheroma volume, total atheroma volume, percent of patients with significant plaque progression, and percent of patients with significant plaque regression.

For all of those variables, there was less progression of disease in patients who achieved LDL-cholesterol ¡Ü 70 mg/dL and systolic blood pressure ¡Ü 120 mmHg in combination.

"The finding that patients who were able to get their LDL below 70 mg/dL and their systolic blood pressure below 120 mmHg had the slowest progression of heart disease supports the growing concept that more than one risk factor is driving the disease," says Stephen J. Nicholls, assistant professor of molecular medicine at the Cleveland Clinic, and co-author of the study. "The thought really needs to be that the greatest bang for your buck in terms of preventing heart disease is going to be by trying to have aggressive control of all the risk factors."

Chhatriwalla et al. "provide an interesting commentary on the need for more aggressive treatment guidelines for 'pre-hypertension,' i.e, blood pressure of 120 to 139/80 to 89 mm Hg in patients with established coronary artery disease," comment Jonathan Tobis, M.D. and Alice Perlowski, M.D., from the David Geffen School of Medicine at UCLA, Los Angeles, California, in an accompanying editorial.

However, they caution that IVUS, although a robust clinical and research tool, is subject to limitations. "Although we may use plaque progression/regression on IVUS to deduce that we are producing positive results for our patients, the true determination of the impact of our therapy depends on clinical and mortality end points, which can only be obtained from large-scale randomized clinical trials."

Dr. Chhatriwalla maintains his study sends an important message. "This study suggests that when it comes to cholesterol and blood pressure targets, 'close' is not good enough. We need to stress that patients with the best risk factor control have the best clinical results. This is the take-home message."

Dr. Chhatriwalla reports no conflict of interest. Dr. Nicholls reports honoraria from Pfizer, AstraZeneca, Takeda, and Merck Schering-Plough; consulting fees from AstraZeneca, Roche, Merck Schering-Plough, Takeda, Pfizer, and Anthera Pharmaceuticals, and research support from AstraZeneca and LipidSciences.

The American College of Cardiology is leading the way to optimal cardiovascular care and disease prevention. The College is a 36,000-member nonprofit medical society and bestows the credential Fellow of the American College of Cardiology upon physicians who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at www.acc.org.

The American College of Cardiology (ACC) provides these news reports of clinical studies published in the Journal of the American College of Cardiology as a service to physicians, the media, the public and other interested parties. However, statements or opinions expressed in these reports reflect the view of the author(s) and do not represent official policy of the ACC unless stated so.

Amanda Jekowsky | EurekAlert!
Further information:
http://www.acc.org

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Stingless bees have their nests protected by soldiers

24.02.2017 | Life Sciences

New risk factors for anxiety disorders

24.02.2017 | Life Sciences

MWC 2017: 5G Capital Berlin

24.02.2017 | Trade Fair News

VideoLinks
B2B-VideoLinks
More VideoLinks >>>