Abstract 5093: Atorvastatin Reduces Macrophage Accumulation in the Atherosclerotic Plaque: A Comparison versus Non-statin Based Regimen in Patients Undergoing Carotid Endarterectomy
Several studies suggested that statins may exert anti-atherosclerotic effects beyond cholesterol lowering. No definite data on humans are available confirming this hypothesis. To compare the effect of high dose vs low dose of atorvastatin vs non-statin based treatment (cholestyramine plus sistosterol) on carotid plaque composition, we studied 60 hypercholesterolemic patients (total cholesterol, TC, 225–295 mg/dl) eligible for carotid endarterectomy. Three months prior surgery patients were randomized into 3 groups (n=20) receiving atorvastatin 10 mg/day (AT-10), or atorvastatin 80 mg/day (AT-80), or cholestyramine 8 g/day plus sitosterol 2.5 g/day (C-S). Blood samples were collected to assess lipid profile and inflammatory markers levels. Analysis of carotid plaque cell composition and lipid content was performed on endarterectomy specimens. The AT-80 group showed the highest reduction in TC and LDL cholesterol (LDL-C) levels. A comparable TC and LDL-C level was achieved in the AT-10 and C-S groups. The three regimens did not significantly influence the levels of inflammatory markers (including hs-PCR). A lower content in macrophages was observed in the AT-10 group plaques compared to the C-S group. The macrophage content was further on reduced in the AT-80 group plaques. No difference in lymphocyte number was observed among treatments while the content of smooth muscle cells was higher in the AT- 80 group. The plaque lipid content was similar in the 3 groups. In conclusion, dspite a comparable reduction in cholesterol levels, atorvastatin treatment was superior to a non-statin based regimen in blunting macrophage accumulation inside carotid atherosclerotic plaque.