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Cited by 2,159Lipoproteins and Cardiovascular HealthCholesterol and Lipid MetabolismAtherosclerosis and Cardiovascular Diseases

Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B

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Brown, Greg, Albers, John J., Fisher, Lloyd D., Schaefer, Susan M., Lin, Jiin-Tarng, Kaplan, Cheryl, Zhao, Xue-Qiao, Bisson, Brad D. +2 more·1990·New England Journal of Medicine
DOI 10.1056/nejm199011083231901
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Abstract

BACKGROUND AND METHODS: The effect of intensive lipid-lowering therapy on coronary atherosclerosis among men at high risk for cardiovascular events was assessed by quantitative arteriography. Of 146 men no more than 62 years of age who had apolipoprotein B levels greater than or equal to 125 mg per deciliter, documented coronary artery disease, and a family history of vascular disease, 120 completed the 2 1/2-year double-blind study, which included arteriography at base line and after treatment. Patients were given dietary counseling and were randomly assigned to one of three treatments: lovastatin (20 mg twice a day) and colestipol (10 g three times a day); niacin (1 g four times a day) and colestipol (10 g three times a day); or conventional therapy with placebo (or colestipol if the low-density lipoprotein [LDL] cholesterol level was elevated). RESULTS: The levels of LDL and high-density lipoprotein (HDL) cholesterol changed only slightly in the conventional-therapy group (mean changes, -7 and +5 percent, respectively), but more substantially among patients treated with lovastatin and colestipol (-46 and +15 percent) or niacin and colestipol (-32 and +43 percent). In the conventional-therapy group, 46 percent of the patients had definite lesion progression (and no regression) in at least one of nine proximal coronary segments; regression was the only change in 11 percent. By comparison, progression (as the only change) was less frequent among patients who received lovastatin and colestipol (21 percent) and those who received niacin and colestipol (25 percent), and regression was more frequent (lovastatin and colestipol, 32 percent; niacin and colestipol, 39 percent; P less than 0.005). Multivariate analysis indicated that a reduction in the level of apolipoprotein B (or LDL cholesterol) and in systolic blood pressure, and an increase in HDL cholesterol correlated independently with regression of coronary lesions. Clinical events (death, myocardial infarction, or revascularization for worsening symptoms) occurred in 10 of 52 patients assigned to conventional therapy, as compared with 3 of 46 assigned to receive lovastatin and colestipol and 2 of 48 assigned to receive niacin and colestipol (relative risk of an event during intensive treatment, 0.27; 95 percent confidence interval, 0.10 to 0.77). CONCLUSIONS: In men with coronary artery disease who were at high risk for cardiovascular events, intensive lipid-lowering therapy reduced the frequency of progression of coronary lesions, increased the frequency of regression, and reduced the incidence of cardiovascular events.

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  • Several studies show that nicotinic acid plus colestipol produces more frequent absolute regression of atherosclerotic lesions than colestipol alone.

    “Several studies have shown that the combination of nicotinic acid and colestipol causes a higher frequency of absolute regression of atherosclerotic lesions than colestipol alone.144”

    From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [144]

  • There have been reports on suspected teratogenicity in pregnant patients who incidentally took statins during early pregnancy.

    “Moreover, there have been reports on suspected teratogenicity in pregnant patients who incidentally took statins during early pregnancy662); therefore, at present, it appears that statins must not be used in women who are pregnant, possibly pregnant, trying to conceive, or lactating.”

    From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [662]

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Authors
Brown, G., Albers, J. J., Fisher, L. D., Schaefer, S. M., Lin, J.-T., Kaplan, C., Zhao, X.-Q., Bisson, B. D., Fitzpatrick, V. F., & Dodge, H. T.
Affiliations
University of Washington (US)
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1990-11-08
Volume
323
Issue
19
Pages
1289-1298
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199011083231901
OpenAlex
W2324712847
Cited by
2,159
References
53
Citations by year
2026: 2 · 2025: 8 · 2024: 10 · 2023: 9 · 2022: 8 · 2021: 3 · 2020: 10 · 2019: 14 · 2018: 13 · 2017: 17 · 2016: 28 · 2015: 29 · 2014: 29 · 2013: 38 · 2012: 48
FWCI
202.83
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01hl019451-14)
  • National Heart, Lung, and Blood Institute (P01HL030086, R01 HL 19451)
  • National Center for Research Resources (RR 37)
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
  • Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
Keywords
coronary artery disease, apolipoprotein B, intensive lipid-lowering therapy, lovastatin, nicotinic acid, colestipol, LDL cholesterol, HDL cholesterol, systolic blood pressure, cardiovascular events, revascularization, myocardial infarction, mortality, nutrition counseling
MeSH terms
Adult, Apolipoproteins B, Colestipol, Coronary Disease, Diet, Double-Blind Method, Drug Therapy, Combination, Humans, Cholesterol, HDL, Cholesterol, LDL, Lovastatin, Male, Middle Aged, Niacin, Multivariate Analysis, Coronary Angiography

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