Aggressively lowering "bad" cholesterol "is at least as good or better" than angioplasty/usual care for preventing and delaying certain cardiac events in selected patients with stable coronary artery disease, report researchers from Emory University and elsewhere in this week?s New England Journal of Medicine.
The authors report results of the Atorvastatin Versus Revascularization Treatment (AVERT) trial -- the first study to directly compare cholesterol-lowering therapy to balloon angioplasty.
Researchers from 37 medical centers in North America and Europe entered into the study 341 patients with stable coronary artery disease. Study subjects were randomized to either receive aggressive cholesterol-lowering therapy with atorvastatin (brand name Lipitor) or to undergo balloon angioplasty and receive "usual" medical care, which may or may not have included some form of cholesterol-lowering therapy.
Taking 80 mg of atorvastatin daily reduced low-density lipoprotein (LDL or "bad") cholesterol levels 46 percent, to an average of 77 mg/dl, among subjects randomized to the "drug" group.
Thirteen percent (22) of the 164 patients assigned to receive the cholesterol-lowering drug went on to experience an ischemic event during the 18-month study period compared to 21 percent (37) of the 177 subjects assigned to the angioplasty/usual care group. This represents a 36 percent reduction in the medically (drug) treated group versus the revascularization group. Ischemic events included cardiac arrest, nonfatal heart attack, cerebrovascular accident (stroke), bypass surgery, angioplasty or cardiac death. In addition, onset of cardiac events was significantly delayed in subjects receiving the cholesterol-lowering agent compared to those in the angioplasty/usual care group, the authors report.