Aggressive Lipid Lowering Reduces Ischemic Events
As Effectively As Angioplasty

	July 8, 1999 - Aggressive lowering of cholesterol
levels with drugs is at least as effective as angioplasty
in treating stable coronary artery disease (CAD), according
to a report in the July 8 issue of The New England Journal
of Medicine.
	Dr. Bertram Pitt and the Atorvastatin Versus
Revascularization Treatment Investigators randomly assigned
341 patients with stable CAD either to receive treatment
with atorvastatin at 80mg per day (164 patients), or to
have angioplasty followed by usual care (177 patients).
	Although the usual care could include therapy with
lipid-lowering drugs, "the patients who were randomly 
assigned to receive atorvastatin had significantly lower
cholesterol levels and triglycerides than the angioplasty
patients."
	"Twenty-two of the patients in the atorvastatin
group (13%) and 37 in the angioplasty group (21%) had
ischemic events, a difference of 36%," the authors write.
"This reduction in events was due to a smaller number of
angioplasty procedures, bypass operations, and
hospitalizations for worsening angina."
	"Treatment with atorvastatin, as compared with
angioplasty, was associated with a significantly longer
time to a first ischemic event," the researchers add.
	When angina alone was analyzed, the angioplasty
group did much better than the atorvastatin group.
There was no difference between the 2 treatment groups
in terms of quality of life or number of adverse events.
	Dr. Pitt's group cautions that if "symptoms
worsen or exercise ability deteriorates to the extent that
it interferes with quality of life, patients may elect to
have angioplasty without any penalty for their initial
decision."

N Engl J Med 1999;341:70-76