Statin Therapy Following Percutaneous Coronary Revascularisation
The success of the 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) in ameliorating atherothrombotic events is firmly established. Large randomised controlled clinical trials have consistently (and unequivocally) demonstrated a beneficial role in reducing coronary events and total mortality in patients with advanced coronary artery disease (CAD). The benefits extend to primary prevention. This success has led investigators to explore mechanisms and to study the role of statins in different patient populations.

The Lescol Intervention Prevention Study (LIPS) falls into the latter category. Percutaneous coronary intervention (PCI) is effective at providing relief from angina in patients with flow-restricting coronary atheroma. The rationale for the study arose from observations that, in spite of symptom palliation, patients continue to have high rates of adverse events after the procedure. Approximately 60% of patients at five years and only 33% at 10 years remain free of major cardiac events. Lipid-rich plaques are vulnerable to rupture. Some may not cause luminal narrowing and these are difficult to diagnose by coronary angiography. There is a need, therefore, for measures to stabilise plaques in conjunction with lowering cholesterol.