Published online before print January 16, 2006, doi: 10.1161/CIRCULATIONAHA.105.568147
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:427-437.)
© 2006 American Heart Association, Inc.
Vascular Medicine |
Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months
A Multicenter, Randomized, Double-Blind Trial
From the Departments of Cardiology (A.S., R.E.) and Pharmacology (W.S.), University Clinic Essen, Essen, Germany; University Clinic Erlangen (S.A.), Erlangen, Germany; Alfried-Krupp-Krankenhaus (T.B., G.K.), Essen, Germany; Cardiovascular Center (Y.B.), Moscow, Russian Federation; Kardiologische Praxis (A.F.), Berlin, Germany; University Clinic Innsbruck (G.F.), Innsbruck, Austria; Royal Brompton Hospital (M.H.), London, United Kingdom; University Clinic Göttingen (F.K.), Göttingen, Germany; Russian Research and Practical Center of Cardiology (V.K.), Moscow, Russian Federation; The Wellington Hospital (A.L.), London, United Kingdom; Kardiologische Praxis (R.L.), Hagen, Germany; Kreiskrankenhaus Traunstein (W.M.), Traunstein, Germany; University Clinic Charite (M.S., E.S.-T., A.V.), Berlin, Germany; Cardiology Research Center (V.S.), Moscow, Russian Federation; and Kardiologische Praxis (B.W.), Essen, Germany.
Correspondence to Axel Schmermund, MD, Cardioangiologisches Centrum Bethanien, Im Prüfling 23, 60389 Frankfurt am Main, Germany. E-mail A.Schmermund{at}ccb.de
Received June 10, 2005; revision received October 20, 2005; accepted October 27, 2005.
Background— Recent clinical trials have suggested that intensive versus standard lipid-lowering therapy provides for additional benefit. Electron-beam computed tomography provides the opportunity to quantify the progression of coronary artery calcification (CAC) in serial measurements.
Methods and Results— In a multicenter, randomized, double-blind trial, 471 patients (age 61±8 years) who had no history of coronary artery disease and no evidence of high-grade coronary stenoses (>50% diameter reduction) were randomized if they had 
2 cardiovascular risk factors and moderate calcified coronary atherosclerosis as evidenced by a CAC score 30. Patients were assigned to receive 80 mg or 10 mg of atorvastatin per day over 12 months. Progression of CAC volume scores could be analyzed in 366 patients. After pretreatment with 10 mg of atorvastatin for 4 weeks, 12 months of study medication reduced LDL cholesterol from 106±22 to 87±33 mg/dL in the group randomized to receive 80 mg of atorvastatin (P<0.001), whereas levels remained stable in the group randomized to receive 10 mg (108±23 at baseline, 109±28 mg/dL at the end of the study, P=NS). The mean progression of CAC volume scores, corrected for the baseline CAC volume score, was 27% (95% CI 20.8% to 33.1%) in the 80-mg atorvastatin group and 25% (95% CI 19.1% to 30.8%) in the 10-mg atorvastatin group (P=0.65). CAC progression showed no relationship with on-treatment LDL cholesterol levels.
Conclusions— We did not observe a relationship between on-treatment LDL cholesterol levels and the progression of calcified coronary atherosclerosis. Over a period of 12 months, intensive atorvastatin therapy was unable to attenuate CAC progression compared with standard atorvastatin therapy. The possibility remains that the time window was too short to demonstrate an effect.
CLINICAL PERSPECTIVE
Related Articles:
-
Issue Highlights
Circulation 2006 113: 329.[Extract] [Full Text]
- Coronary Artery Calcium: Should We Rely on This Surrogate Marker?
- Rita F. Redberg
Circulation 2006 113: 336-337.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  M K. Shea, C. J O'Donnell, U. Hoffmann, G. E Dallal, B. Dawson-Hughes, J. M Ordovas, P. A Price, M. K Williamson, and S. L Booth Vitamin K supplementation and progression of coronary artery calcium in older men and women Am. J. Clinical Nutrition, June 1, 2009; 89(6): 1799 - 1807. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Demer and Y. Tintut Vascular Calcification: Pathobiology of a Multifaceted Disease Circulation, June 3, 2008; 117(22): 2938 - 2948. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. V. Anand, E. Lim, D. Darko, P. Bassett, D. Hopkins, D. Lipkin, R. Corder, and A. Lahiri Determinants of Progression of Coronary Artery Calcification in Type 2 Diabetes: Role of Glycemic Control and Inflammatory/Vascular Calcification Markers J. Am. Coll. Cardiol., December 4, 2007; 50(23): 2218 - 2225. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Erbel, S. Mohlenkamp, G. Kerkhoff, T. Budde, and A. Schmermund Non-invasive screening for coronary artery disease: calcium scoring Heart, December 1, 2007; 93(12): 1620 - 1629. [Full Text] [PDF]
|
|
|
|
|
|
A. E. Cassidy-Bushrow, L. F. Bielak, P. F. Sheedy II, S. T. Turner, I. J. Kullo, X. Lin, and P. A. Peyser Coronary Artery Calcification Progression Is Heritable Circulation, July 3, 2007; 116(1): 25 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Waxman, F. Ishibashi, and J. E. Muller Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events Circulation, November 28, 2006; 114(22): 2390 - 2411. [Full Text] [PDF]
|
|
|
|
|
|
S. J. Nicholls, E. M. Tuzcu, K. Wolski, I. Sipahi, P. Schoenhagen, T. Crowe, S. R. Kapadia, S. L. Hazen, and S. E. Nissen Coronary Artery Calcification and Changes in Atheroma Burden in Response to Established Medical Therapies J. Am. Coll. Cardiol., November 8, 2006; (2006) j.jacc.2006.10.038v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Romanens and A. R. Miserez Letter by Romanens and Miserez Regarding Article, "Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months: A Multicenter, Randomized, Double-Blind Trial" Circulation, September 19, 2006; 114(12): e506 - e506. [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund, W. Siffert, R. Erbel, S. Achenbach, T. Budde, G. Kerkhoff, Y. Buziashvili, A. Forster, G. Friedrich, M. Henein, et al. Response to Letter Regarding Article, "Effect of Intensive Versus Standard Lipid-Lowering Treatment With Atorvastatin on the Progression of Calcified Coronary Atherosclerosis Over 12 Months: A Multicenter, Randomized, Double-Blind Trial" Circulation, September 19, 2006; 114(12): e507 - e508. [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Crouse III Thematic review series: Patient-Oriented Research. Imaging atherosclerosis: state of the art J. Lipid Res., August 1, 2006; 47(8): 1677 - 1699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schmermund and R. Erbel Letter by Schmermund and Erbel Regarding Article, "Coronary Artery Calcium: Should We Rely on This Surrogate Marker?" Circulation, August 1, 2006; 114(5): e82 - e82. [Full Text] [PDF]
|
|
|
|
|
|
R. F. Redberg Response to Letter Regarding Article, "Coronary Artery Calcium: Should We Rely on This Surrogate Marker?" Circulation, August 1, 2006; 114(5): e83 - e83. [Full Text] [PDF]
|
|
|
|
|
|
R. F. Redberg Coronary Artery Calcium: Should We Rely on This Surrogate Marker? Circulation, January 24, 2006; 113(3): 336 - 337. [Full Text] [PDF]
|
|