Statin treatment for coronary artery plaque composition based on intravascular ultrasound radiofrequency data analysis

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• 作者：Tsuyoshi Nozue ; MD^a ; ^o ; ^{nozue2493@yahoo.co.jp} ; Shingo Yamamoto ; MD^b ; ^o ; Shinichi Tohyama ; MD^c ; ^o ; Shigeo Umezawa ; MD^d ; ^o ; Tomoyuki Kunishima ; MD^e ; ^o ; Akira Sato ; MD^f ; ^o ; Shogo Miyake ; MD^g ; ^o ; Youichi Takeyama ; MD^h ; ^o ; Yoshihiro Morino ; MDⁱ ; ^o ; Takao Yamauchi ; MD^j ; ^o ; Toshiya Muramatsu ; MD^k ; ^o ; Kiyoshi Hibi ; MD^l ; ^o ; Takashi Sozu ; PhD^m ; ^o ; Mitsuyasu Terashima ; MDⁿ ; ^o ; Ichiro Michishita ; MD^a ; ^o
• 刊名：American Heart Journal
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：163
• 期：2
• 页码：191-199.e1
• 全文大小：293 K

文摘

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Background

Systemic therapy with statin has been shown to lower the risk of coronary events; however, the in vivo effects of statin therapy on plaque volume and composition are less understood.

Methods

We conducted a prospective, open-labeled, randomized, multicenter study in 11 centers in Japan. A total of 164 patients were randomized to receive either 4 mg/d of pitavastatin (intensive lipid-lowering therapy) or 20 mg/d of pravastatin (moderate lipid-lowering therapy). Analyzable intravascular ultrasound data were obtained for 119 patients at baseline and at 8-month follow-up. The primary end point was the difference of volume changes in each of the 4 main plaque components (fibrosis, fibrofatty, calcium, and necrosis), assessed by virtual histology intravascular ultrasound, between the 2 groups.

Results

The mean low-density lipoprotein cholesterol level at follow-up was significantly lower in the pitavastatin than in the pravastatin group (74 vs 95 mg/dL, P < .0001). During the 8-month follow-up period, statin therapy reduced the absolute and relative amount of fibrofatty component (pitavastatin: from 1.09 to 0.81 mm³/mm, P = .001; pravastatin: from 1.05 to 0.83 mm³/mm, P = .0008) and increased in the amount of calcium (pitavastatin: from 0.42 to 0.55 mm³/mm, P < .0001; pravastatin: from 0.44 to 0.55 mm³/mm, P = .005), whereas volume changes in both plaque components were not statistically different between the 2 groups.

Conclusions

Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the fibrofatty plaque component and increasing the calcified plaque component.