Summary
An understanding of how angiographic progression correlates with events is useful at this time for two reasons. First, to more fully comprehend the contribution of these trials in the past and second, to interpret trials which are currently underway or in the planning stages. A grave disservice has been done to the angiographic trials by introduction of the concept of “small angiographic change” leading to a “large reduction in events”. The former is due solely to the denominator effect and the latter was not generally seen, at lest in terms of the traditional endpoint of death from coronary disease plus non-fatal myocardial infarction. The predictive power of angiographic progression of future clinical events (its ability to serve as a “surrogate”) has been demonstrated during long term follow-up of three major angiographic trials. The success of sequential angiography to serve as a surrogate is probably based on the fact that angiography can detect plaque rupture. Thus angiographic trials could best be referred to as “plaque repture trails”.
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References
Steiner G. The Diabetes Atherosclerosis Intervention Study (DAIS): a study conducted in cooperation with the World Health Organization. The DAIS Project Group. Diabetologia 1996;39:1655–1661.
The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary artery bypass grafts. The Post Coronary Artery Bypass Graft Trial Investigators. N Engl J Med 1997;336:153–162.
Bemis CE, Gorlin R, Kemp HG, Herman MV. Progression of coronary artery disease. A clinical arteriographic study. Circulation 1973;47:455–464.
Ost CR, Stenson S. Regression of peripheral atherosclerosis during therapy with high doses of nicotinic acid. Scand J Clin Lab Invest Suppl 1967;99:241–245.
Barndt R Jr, Blankenhorn DH, Crawford DW, Brooks SH. Regression and progression of early femoral atherosclerosis in treated hyperlipoproteinemic patients. Ann Intern Med 1977;86:139–146.
Blankenhorn DH, Brooks SH, Selzer RH, Barndt R Jr. The rate of atherosclerosis change during treatment of hyperlipoproteinemia. Circulation 1978;57:355–361.
Brensike JF, Levy RI, Kelsey SF et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II Coronary Intervention Study. Circulation 1984;69:313–324.
Arntzenius AC, Kromhout D, Barth JD et al. Diet, lipoproteins, and the progression of coronary atherosclerosis: The Leiden Intervention Trial. N Engl J Med 1985;312:805–811.
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atheroclerosis and coronary venous bypass grafts [published erratum appears in JAMA 1988;259:2698]. JAMA 1987;257:3233–3240.
Cashin-Hemphill L, Mack WJ, Pogoda J, Sanmarco ME, Azen SP, Blankenhorn DH. Beneficial effects of colestipol-niacin on coronary atherosclerosis. A 4-year follow-up. JAMA 1990;264:3013–3017.
Buchwald H, Varco RL, Matts JP et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 1990;323:946–955.
Brown G, Albers JJ, Fisher LD et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med 1990;323:1289–1298.
Watts GF, Lewis B, Brunt JNH et al. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St Thomas’ Atherosclerosis Regression Study (STARS). Lancet 1992;339:563–569.
Blankenhorn DH, Azen SP, Kramsch DM et al. Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS). The MARS Research Group. Ann Intern Med 1993;119:969–976.
Effect of simvastatin on coronary atheroma: the Multicentre Anti-Atheroma Study (MAAS) [published erratum appears in Lancet 1994;344:762]. Lancet 1994;344:633–638.
Haskell WL, Alderman EL, Fair JM et al Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994;89:975–990.
Waters D, Higginson L, Gladstone P et al. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography. The Canadian Coronary Atherosclerosis Intervention Trial. Circulation 1995;89:959–968.
Pitt B, Mancini GBJ, Ellis SG, Rosman HS, Park JS, McGovern ME. Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): reduction in atherosclerosis progression and clinical events. PLAC I investigation. J Am Coll Cardiol 1995;26:1133–1139.
Jukema JW, Bruschke AVG, Van Boven AJ et al. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men wtih normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS). Circulation 1995;91:2528–2540.
Ericsson CG, Hamsten A, Nilsson J, Grip L, Svane B, De Faire U. Angiographic assessment of effects of bezafibrate on progression of coronary artery disease in young male postinfarction patients. Lancet 1996;347:849–853.
Niebauer J, Hambrecht R, Velich T et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997;96:2534–2541.
Frick MH, Syvanne M, Nieminen MS et al.. Prevention of the angiographic progression of coronary and vein-graft atherosclerosis by gemfibrozil after coronary bypass surgery in men with low levels of HDL cholesterol. Lopid Coronary Angiography Trial (LOCAT) Study Group. Circulation 1997;96:2137–2143.
Herd JA, Ballantyne CM, Farmer JA et al. Effects of fluvastatin on coronary atherosclerosis in patients with mild to moderate cholesterol elevations (Lipoprotein and Coronary Atherosclerosis Study [LCAS]). Am J Cardiol 1997;80:278–286.
Sobel BE, Furberg CD. Surrogates, semantics, and sensible public policy. Circulation 1997;95:1661–1663.
Leung WH, Alderman EL, Lee TC, Stadius ML. Quantitative arteriography of apparently normal coronary segments with nearby or distant disease suggests presence of occult, nonvisualized atherosclerosis. J Am Coll Cardiol 1995;25:311–317.
Moise A, Bourassa MG, Theroux P et al. Prognostic significance of progression of coronary artery disease. AmJ Cardiol 1985;55:941–946.
Buchwald H, Matts JP, Fitch LL et al Changes in sequential coronary arteriograms and subsequent coronary events. Surgical Control of the Hyperlipidemias (POSCH) Group. JAMA 1992;268:1429–1433.
Waters D, Craven TE, Lesperance J. Prognostic significance of progression of coronary atherosclerosis. Circulation 1993;87:1067–1075.
Azen SP, Mack WJ, Cashin-Hemphill L et al. Progression of coronary artery disease predicts clinical coronary events. Long-term follow-up from the Cholesterol Lowering Atherosclerosis Study. Circulation 1996;93:34–41.
Harrison DG. Endothelial dysfunction in atherosclerosis. Basic Res Cardiol 1994;89(Suppl 1):87–102.
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Cashin-Hemphill, L. (1998). How well does angiographic progression correlate with clinical events?. In: Reiber, J.H.C., Van Der Wall, E.E. (eds) What’s New in Cardiovascular Imaging?. Developments in Cardiovascular Medicine, vol 204. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-5123-8_8
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DOI: https://doi.org/10.1007/978-94-011-5123-8_8
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