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(Circulation. 2004;110:2336-2341.)
© 2004 American Heart Association, Inc.

Coronary Heart Disease

Statin-Induced Cholesterol Lowering and Plaque Regression After 6 Months of Magnetic Resonance Imaging–Monitored Therapy

João A.C. Lima, MD; Milind Y. Desai, MD; Henning Steen, MD; William P. Warren, MD; Sandeep Gautam, MD; Shenghan Lai, MD, PhD

From the Cardiology Division of the Department of Medicine (J.A.C.L., M.Y.D., H.S., W.P.W., S.G.), the Department of Radiology (J.A.C.L.) of the School of Medicine, and the Department of Epidemiology of the Bloomberg School of Hygiene and Public Health (J.A.C.L., S.L.), Johns Hopkins University, Baltimore, Md.

Correspondence to João A.C. Lima, MD, Cardiology Division, Blalock 524, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287. E-mail jlima{at}jhmi.edu

Received March 29, 2004; de novo received May 27, 2004; revision received June 30, 2004; accepted July 13, 2004.

Background— Statin therapy reduces adverse outcomes, with a minimal decrease in vessel stenosis. Magnetic resonance imaging (MRI) noninvasively detects atherosclerotic plaque (AP) reduction. We hypothesized that statin-induced AP regression can be monitored by MRI and detected earlier than previously reported and is significantly associated with its lipid-lowering effect.

Methods and Results— APs in thoracic aorta were measured by combined surface/transesophageal MRI in 27 patients (treated with simvastatin 20 to 80 mg daily) before and after 6 months of therapy. AP volume and luminal dimensions were measured from 6 cross sections used to construct a 2.4-cm 3D volume of the aorta that included plaque and lumen. Method reproducibility was studied in 10 patients imaged twice, 1 week apart. AP volume was reduced from 3.3±0.1.4 to 2.9±1.4 cm³ at 6 months (P<0.02), whereas luminal volume increase was less accentuated (from 12.0±3.9 to 12.2±3.7 cm³, P<0.06). LDL cholesterol decreased by 23% (from 125±32 to 97±27 mg/dL, P<0.05) in 6 months. AP regression (plaque volume/area reduction) was significantly related to LDL cholesterol reduction (P<0.02 and P<0.005, respectively), and luminal volume increase was inversely related to LDL cholesterol reduction (P<0.04). Plaque volume measurement was highly reproducible (intraclass correlation R=0.98 and variability=4.8%). Intraobserver (0.91) and interobserver (0.81) concordances were documented for plaque volume assessment.

Conclusions— AP regression and reverse remodeling can be detected accurately by MRI 6 months after statin therapy initiation, and it is strongly associated with LDL cholesterol reduction.

Key Words: lipids • atherosclerosis • plaque • magnetic resonance imaging

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