Published online before print July 6, 2004, doi: 10.1161/01.CIR.0000135215.75876.41
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(Circulation. 2004;110:265-270.)
© 2004 American Heart Association, Inc.
Original Articles |
Regression of Coronary Atherosclerosis by Simvastatin
A Serial Intravascular Ultrasound Study
From the Department of Cardiology, Odense University Hospital (L.O.J., P.T., K.E.P., T.H.), Odense, and the Department of Clinical Biochemistry, Gentofte Hospital (S.S.), Gentofte, Denmark.
Correspondence to Lisette Okkels Jensen, MD, PhD, Department of Cardiology, Catheterization Laboratorium, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark. E-mail okkels{at}dadlnet.dk
Received November 6, 2003; de novo received January 7, 2004; revision received March 25, 2004; accepted March 29, 2004.
Background— Angiography of the coronary arteries reflects only changes in luminal dimensions. With intravascular ultrasound, cross-sectional images can be obtained and area measurements can be added to calculate volumes of the external elastic membrane (EEM), plaque plus media (P+M), and lumen. The aim of this study was to investigate the effect of lipid lowering by simvastatin on coronary atherosclerotic P+M as changes in volumes of EEM, P+M, and lumen.
Methods and Results— In 40 male patients with hypercholesterolemia, ischemic heart disease, and a nonsignificant coronary artery lesion in a not previously revascularized coronary artery, serial intravascular ultrasound studies with an ECG-triggered pullback were performed at baseline, after 3 months on a lipid-lowering diet, and after another 12 months on simvastatin 40 mg/d. Mean length of the analyzed atherosclerotic segments was 5.9±3.3 mm. After 12 months on simvastatin, a significant reduction in P+M volume of 6.3% (P=0.002) was observed, whereas only a nonsignificant reduction in EEM volume of 1.8% was seen without any concomitant change in lumen volume. A significant reduction in total cholesterol of 31.0% (6.1±0.8 versus 4.2±0.7 mmol/L, P<0.001) and LDL cholesterol of 42.6% (4.0±0.8 versus 2.2±0.6 mmol/L, P<0.001) was obtained.
Conclusions— Lipid-lowering therapy with simvastatin for 12 months is associated with a significant P+M regression in coronary arteries measured as reduction in P+M and EEM volumes without any concomitant change in lumen volume.
Key Words: atherosclerosis • plaque • remodeling • lipids • ultrasonics
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