Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study

• Published in: Heart and vessels Vol. 32; no. 5; pp. 539 - 548
• Main Authors: Kawashiri, Masa-aki, Sakata, Kenji, Hayashi, Kenshi, Gamou, Tadatsugu, Kanaya, Honin, Miwa, Kenji, Ueda, Kosei, Higashikata, Toshinori, Mizuno, Sumio, Michishita, Ichiro, Namura, Masanobu, Nitta, Yutaka, Katsuda, Shoji, Okeie, Kazuyasu, Hirase, Hiroaki, Tada, Hayato, Uchiyama, Katsuharu, Konno, Tetsuo, Ino, Hidekazu, Nagase, Keisuke, Yamagishi, Masakazu
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.05.2017; Springer Nature B.V
• Subjects: Aged; Antihypertensive Agents - therapeutic use; Biomedical Engineering and Bioengineering; Blood Pressure - drug effects; Cardiac Surgery; Cardiology; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - therapy; Disease Progression; Female; Follow-Up Studies; Humans; Hypolipidemic Agents - therapeutic use; Lipids - blood; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Ischemia - diagnosis; Myocardial Ischemia - etiology; Myocardial Ischemia - therapy; Original Article; Percutaneous Coronary Intervention; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnosis; Plaque, Atherosclerotic - therapy; Prospective Studies; Time Factors; Ultrasonography, Interventional - methods; Vascular Surgery; Amlodipine; Atorvastatin; Coronary plaque volume; Intravascular ultrasound
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-016-0910-2

The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0 ± 9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18–24 months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100 mg/dL and 140/90 mmHg vs. 70 mg/dL and 120/70 mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9 ± 14.7 vs. 63.7 ± 11.9 mg/dL (NS) and 124.1 ± 9.4/75.8 ± 7.7 vs. 113.6 ± 9.6/65.8 ± 9.4 mmHg (systolic BP; NS, diastolic BP; p  < 0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of −9.4 ± 10.7% and −8.7 ± 8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.