Pravastatin (mevalotin) restenosis trial after percutaneous transluminal coronary angioplasty. Cholesterol reduction rate determines the restenosis rate.

There is no consensus on lipids and restenosis after percutaneous transluminal coronary angioplasty (PTCA). We evaluated whether prevastatin could prevent restenosis after PTCA. In this study, pravastatin therapy was started one month before PTCA. The follow-up angiography was done three months later. Total cholesterol reduction rates [one index of reduction rate is calculated between 1 M (month) before PTCA and at PTCA, and another done between 1 M before PTCA and at follow-up angiography] proved to be good predictors of restenosis rate after PTCA; The greater the cholesterol reduction rate, the lower the rate of restenosis. The residual stenosis after PTCA correlated with the restenosis rate. The restenosis rate in the pravastatin group was lower than that in the control group, but the difference was not statistically significant. However, in the subgroup with pre-PTCA restenosis of 99% or more, the restenosis rate in the pravastatin group was significantly lower than that of the control group. Pravastatin seems to prevent intimal hyperplasia through the reduction of cholesterol level and to reduce restenosis. Many macrophages are present in the highly stenosed or occluded coronary arteries, and the reduction of the number and the activity of macrophages may prevent the restenosis. Pravastatin also has an antithrombotic action. In such regions, the occlusion by the thrombus formation is also considered to play a key role in restenosis in addition to the intimal hyperplasia. Thus, pravastatin may be useful especially for PTCA against highly stenosed or occluded coronary arteries.