Circulation. 2001;104:387-392
doi: 10.1161/hc2901.093188
doi: 10.1161/hc2901.093188
(Circulation. 2001;104:387.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Use of Intravascular Ultrasound to Compare Effects of Different Strategies of Lipid-Lowering Therapy on Plaque Volume and Composition in Patients With Coronary Artery Disease
From the Universitaetsklinikum Charité, Campus Virchow, and German Heart Institute Berlin (M.S., W.B.), Krankenhaus am Urban (S.B.), and Universitaetsklinikum Charité Campus Buch und Franz-Volhard-Klinik (M.G.), Berlin; Universitaetsklinikum Hamburg-Eppendorf (D.H.K.), Hamburg; Klinikum der Stadt Mannheim (W.V.), Mannheim; Medizinische Klinik der Eberhard-Karls Universitaet Tuebingen (K.R.K.), Tuebingen; Medizinische Klinik der Ruprecht-Karls-Universitaet Heidelberg (J.K.), Heidelberg; and Medizinische Hochschule Hannover (D.H.), Hannover, Germany.
Reprint requests to Prof Dr M. Schartl, Universitaetsklinikum Charité, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany. E-mail michael.schartl{at}charite.de
Background— We studied whether lipid-lowering therapy with atorvastatin (target LDL cholesterol [LDL-C] <100 mg/dL) compared with a moderate treatment regimen that used other lipid-lowering drugs led to a lesser progression of atherosclerosis and to different changes in plaque echogenicity in patients with coronary artery disease.
Methods and Results— This study was a 12-month, open-label, randomized, multicenter trial, which used serial 3D intracoronary ultrasound to calculate plaque volume and plaque echogenicity. After transcatheter therapy, 131 patients were randomized (atorvastatin n=65, usual care n=66). The target plaque had to be a minor lesion (ie, a diameter stenosis of <50% on angiography). After 12 months, mean LDL-C was reduced from 155 to 86 mg/dL in the atorvastatin group and from 166 to 140 mg/dL in the usual care group. Mean absolute plaque volume showed a larger increase in the usual care group compared with the atorvastatin group (usual care 9.6±28.1 mm3, atorvastatin 1.2±30.4 mm3; P=0.191). The hyperechogenicity index of the plaque increased to a larger extent for the atorvastatin group than for the usual care group, with a significant treatment effect for the percent change (atorvastatin 42.2%, usual care 10.1%; P=0.021).
Conclusions— One year of lipid-lowering therapy to <100 mg/dL LDL-C most likely led to a slowdown of plaque growth of minor lesions. The significantly larger increase in plaque hyperechogenicity is most likely due to a change in plaque composition.
Key Words: arteriosclerosis • coronary disease • lipids • plaque • ultrasonics
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