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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

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Abstract

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.

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Acknowledgements

We express our special thanks to Kazuko Honda (staff of Kanazawa University) for her outstanding technical assistance.

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Authors and Affiliations

  1. Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan

    Masa-aki Kawashiri, Kenji Sakata, Kenshi Hayashi, Tadatsugu Gamou, Hayato Tada, Katsuharu Uchiyama, Tetsuo Konno & Masakazu Yamagishi

  2. Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Honin Kanaya & Kenji Miwa

  3. Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan

    Kosei Ueda, Toshinori Higashikata & Hidekazu Ino

  4. Department of Cardiology, Fukui Cardiovascular Center, Fukui, Japan

    Sumio Mizuno

  5. Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan

    Ichiro Michishita

  6. Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan

    Masanobu Namura

  7. Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan

    Yutaka Nitta & Shoji Katsuda

  8. Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan

    Kazuyasu Okeie

  9. Department of Internal Medicine, Takaoka Municipal Hospital, Takaoka, Japan

    Hiroaki Hirase

  10. Division of Medical Sciences, Kanazawa University Graduate School of Medicine, Kanazawa, Japan

    Keisuke Nagase

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  1. Masa-aki Kawashiri
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  2. Kenji Sakata
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Behalf of the MILLION Study Group

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Correspondence to Masakazu Yamagishi.

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This work was partly supported by the research Grant from Pfizer Ltd.

Conflict of interest

Dr. Yamagishi got a research grant from Pfizer Ltd.

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Kawashiri, Ma., Sakata, K., Hayashi, K. et al. 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. Heart Vessels 32, 539–548 (2017). https://doi.org/10.1007/s00380-016-0910-2

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  • DOI: https://doi.org/10.1007/s00380-016-0910-2

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