1996 Volume 23 Issue 10 Pages 619-623
Target levels for plasma lipids to prevent progression of coronary atherosclerosis has not been established in Japan. We retrospectively investigated to which levels we should reduce the plasma lipids in patients with coronary artery disease.
Eighty-one patients, who have undergone croronary arteriography twice in the same projections at more than 12 months interval, were selected. Quantitative analyses of coronary arteriography were done by Kontron Cardio 500. Progression and regression were defined as a change in the minimum diameter of the stenosis of 0.4mm or more. Progression of coronary lesions was noted in 33 patients (progression group), and no progression in 48 patients (non-progression group).
There were no significant differences in baseline characteristics between the two groups. Mean follw-up time was 38 months. In the progression group, the mean levels of total, LDL and HDL cholesterol, and triglycerides at baseline, were 217mg/dl, 147mg/dl, 38mg/dl and 158mg/dl. In the non-progression group, each of them at baseline was 200mg/dl, 131mg/dl, 40mg/dl and 146mg/dl. There were significant differences between the two groups in total cholesterol (TC) level and LDL-cholesterol (LDL-C) level at baseline. Significant change during follow-up was obtained only in HDL-cholesterol (HDL-C) level from 40mg/dl to 45mg/dl.
We examined distribution of plasma lipids levels. At baseline, the peak count of patients was noted at TC levels of 200 to 220mg/dl in the progression group, and at 180 to 200mg/dl in the non-progression group. namely, the boundary of TC levels between the two groups was 200mg/dl. In the progression group, TC levels at baseline were all above 160mg/dl. The boundary of LDL-C levels at baseline was 120mg/dl, and that of HDL-C afer follow-up was 40mg/dl. In the progression group, HDL-C levels after follow-up were all below 55mg/dl. The peak count of patients was noted at TG levels of 100 to 150mg/dl at baseline in the both groups. The prevalence of TG levels of 150 to 250mg/dl at baseline was 19% in the non-progression group, and 36% in the progression group. The boderline level of TC/HDL-C at baseline was 5, and the prevalence of TC-HDL-C levels of 4 or higher was was in excess of 95% in the progression group.
This study showed that recommendations for plasma lipids management to prevent progression of coronary atherosclerotic lesions might be following: 1) TC and LDL-C levels should be reduced at least to 200mg/dl or lower and to 130mg/dl or lower as soon as possible, and lower target levels for TC and LDL-C were 180 to 160mg/dl and 120 to 100mg/dl; 2) HDL-C levels should be elevated to 40mg/dl or higher, and higher target levels for HDL-C were 50 to 55mg/dl; 4) TG levels should be kept under 150mg/dl; 5) TC/HDL-C levels should be reduced to 5 or lower, and the lower target levels for TC/HDL-C were 4.
