Objective: This prospective study was carried out to evaluate the benefits of intensive lowering of low-density lipoprotein cholesterol (LDL-C) with statin and intensive blood pressure (BP)-lowering therapy as aggressive medical interventions after stent implantation.
Methods: Fifty-four patients with coronary artery disease initially received statin immediately after successful stent implantation. They were divided into intensive therapy (IT group, n = 27; therapeutic target levels of LDL-C and BP were 60 mg/dl and <120/80 mmHg at follow-up coronary angiography, respectively, 6-8 months after stent implantation) and conventional therapy groups (CT group, n = 27; target levels of LDL-C and BP were 100 mg/dl and <130/85 mmHg, respectively). Additional antihypertensive therapy with angiotensin II type 1 receptor blockers was begun according to the BP levels.
Results: There were significant differences in the levels of LDL-C at follow-up between the IT and CT groups [average, 68+/-10 (cut-off value,>or=83.4) mg/dl and 102+/-14 (<83.4) mg/dl, respectively]. Percentage diameter stenosis (P = 0.039) and diastolic BP (P = 0.005) in the IT group were significantly decreased compared with those in the CT group at follow-up. In addition, percentage diameter stenosis was most significantly related to the level of LDL-C (P = 0.03) among other metabolic factors (BP, body mass index, triglyceride, high-density lipoprotein cholesterol, hemoglobin A1c, and adiponectin) at follow-up as assessed by a stepwise multivariable regression analysis.
Conclusion: These results suggest that intensive lowering of LDL-C by statin decreased the neointimal formation after stent implantation, and an LDL-C level of at least 83.4 mg/dl was the most acceptable clinical therapeutic target at follow-up.