Long-Term Effects of Cholesterol Lowering and Angiotensin-Converting Enzyme Inhibition on Coronary Atherosclerosis
Key result
Simvastatin significantly reduced coronary atherosclerosis progression compared to placebo (change in mean diameter -0.07 vs -0.14 mm; P=0.004), while enalapril showed neutral angiographic effects.
Why the study?
Does simvastatin and/or enalapril improve quantitative coronary angiographic measures in normocholesterolemic patients with coronary atherosclerosis?
Population
460 normocholesterolemic patients with coronary atherosclerosis
Comparison
Simvastatin and/or enalapril in a 2x2 factorial… vs Simvastatin placebo and/or enalapril placebo
Design
RCT, randomized, 2 x 2 factorial, double-blind, placebo-controlled
Follow-up
average 47.8 months
Authors
Discussion
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Implication
Supports statin therapy to slow atherosclerosis progression in normocholesterolemic CAD; extends angiographic benefits beyond hypercholesterolemia.
Study Design
Type
RCT (n=460)
Blinding
Double-blind
Randomization
2 x 2 factorial
Multicenter
Yes
Structured PICO
Does simvastatin and/or enalapril improve quantitative coronary angiographic measures in normocholesterolemic patients with coronary atherosclerosis?
P
Population
460 normocholesterolemic patients with coronary atherosclerosis
I
Intervention
Simvastatin and/or enalapril in a 2x2 factorial design
C
Comparator
Simvastatin placebo and/or enalapril placebo
O
Outcome
Changes in quantitative coronary angiographic measures (mean diameters, minimum diameters, and percent diameter stenosis) at average 47.8 months follow-upsurrogate
Main Result
Absolute Event Rate: -0.07% vs -0.14%
p-value: p=0.004
Simvastatin, but not enalapril, slows angiographic progression of coronary atherosclerosis in normocholesterolemic patients, though enalapril may reduce hard clinical events.
Cite This Study
Teo et al. (2000) conducted an RCT in Coronary atherosclerosis (n=460). Simvastatin and Enalapril vs. Placebo was evaluated on Change in mean coronary diameter (mm) (p=0.004). Simvastatin significantly reduced coronary atherosclerosis progression compared to placebo (change in mean diameter -0.07 vs -0.14 mm; P=0.004), while enalapril showed neutral angiographic effects.