Relation of aggressiveness of lipid-lowering treatment to changes in calcified plaque burden by electron beam tomography

The comparative effects of more versus less aggressive low-density lipoprotein (LDL) cholesterol lowering (to ≤80 vs >80 mg/dl) on calcified coronary plaque progression by electron beam tomography were evaluated in 182 consecutive asymptomatic patients after 1.2 years of treatment with statins alone or in combination with niacin. Despite the greater improvement in lipids in the ≤80 versus >80 mg/dl groups, there were no differences in calcified plaque progression (9.3%/year vs 9.1%/year). We conclude that, with respect to LDL cholesterol lowering, “lower is better” is not supported by changes in calcified plaque progression.