- 作者：Makiko Yogo ; Makoto Sasaki ; Makoto Ayaori ; Teruyoshi Kihara ; Hiroki Sato ; Shunichi Takiguchi ; Harumi Uto-Kondo ; Emi Yakushiji ; Kazuhiro Nakaya ; Tomohiro Komatsu ; Yukihiko Momiyama ; Masayoshi Nagata ; Soichiro Mochio ; Yasuyuki Iguchi ; Katsunori Ikewaki
- 关键词：Aortic plaques ; MRI ; Titration of rosuvastatin ; Intensive therapy ; hsCRP
- 刊名：Atherosclerosis
- 出版年：January, 2014
- 年：2014
- 卷：232
- 期：1
- 页码：31-39
- 全文大小：1151 K
Objective
Although previous randomized clinical trials established a basis for lipid guidelines worldwide, they employed fixed doses of statins throughout trials (fire-and-forget approach). In the real clinical setting, however, statin doses are titrated to achieve target low-density lipoprotein cholesterol (LDL-C) levels (treat-to-target approach). The major objective was to investigate whether intensive lipid-lowering therapy using the treat-to-target approach yielded greater regression of aortic plaques.Methods
We therefore performed a prospective, randomized trial comparing the effects of standard (achieve LDL-C levels recommended by the Japanese guidelines) and intensive (achieve 30% lower LDL-C levels than standard) rosuvastatin therapy for 1 year in 60 hypercholesterolemic patients with a primary endpoint of aortic atherosclerotic plaques evaluated by non-invasive magnetic resonance imaging (MRI).
Results
Average doses were 2.9聽卤聽3.1 and 6.5聽卤聽5.1聽mg/day for standard (n聽=聽29) and intensive therapy group (n聽=聽31), respectively. Although both therapies significantly reduced LDL-C and high-sensitivity C-reactive protein (hsCRP) levels, LDL-C reduction was significantly greater in the intensive group (鈭?6 vs.聽鈭?4%). MRI study showed that thoracic aortic plaques were significantly regressed in both groups, with greater regression of thoracic plaque in the intensive group (鈭?.1 vs.聽鈭?.2%, p聽=聽0.01). Multivariate analyses revealed that thoracic plaque regression was significantly correlated with hsCRP reduction, but not with changes in serum lipids, endothelial function, or doses of rosuvastatin.
Conclusion
Intensive statin therapy with titration targeting lower LDL-C levels resulted in greater thoracic aortic plaque regression compared to standard therapy, which was correlated with hsCRP reduction, suggesting that intensive statin therapy could provide better clinical outcomes.