Abstract 209: A Combination Therapy With Statin and Angiotensinii Receptor Blocker is More Effective Than Statin Alone in Preventing Atherosclerotic Progression in Patients With Coronary Artery Disease
Background: Many studies have shown beneficial effects of statins on the inhibition of coronary atherosclerosis. Similarly, studies have revealed that rennin-angiotensin system (RAS) inhibitors suppress atherosclerotic progression and reduce cardiovascular events. However, it remains unknown whether a combination therapy with statin and RAS inhibitor could inhibit plaque progression more effectively than statin alone in patients with coronary artery disease (CAD).
Methods: Using 64-multislice computed tomography, plaque areas (PAs) and total vascular areas (TVAs) in the left main (LMT) and proximal right coronary arteries (RCA) and thoracic descending aorta (TDA) were determined before and after 2.0-year follow-up period in 39 CAD patients (67±10yo) treated with statin and angiotensinII type 1 receptor (AT1R) blocker (n=23) or with statin alone (n=16), Coronary plaques starting from each ostial level in 0.5-mm steps were determined with CT densities between 0 HU and 0.65 × the ascending aortic CT densities. PAs of TDA were determined by the manual tracing of axial images at a 2.0-mm interval from the ostial level of the RCA. Plasma levels of hsCRP, matrix metalloproteinase (MMP)-9 and urinary 8-iso-prostaglandin F2α (PGF) were determined at baseline.
Results: There were no significant differences in LDL-(102±23 vs 91±27mg/dl) and HDL-cholesterol (46±9 vs 53±21mg/dl) levels between the combination therapy and monotherapy groups. At baseline, both PAs and TVAs were greater in the combination therapy group than in the monotherapy group in TDA and RCA. Two years later, increases in PAs were less in the combination therapy group than in the monotherapy group in TDA (2.2±23.1 vs 28.6±25.5mm2, p<0.01), RCA (−1.1±1.9 vs 0.6±2.5mm2, p=0.03) and LMT (−0.9±3.3 vs 1.3±2.4mm2, p=0.08). There was a trend toward inhibition of increasing TVAs with the combination therpy, i.e., attenuation of positive remodeling in all vessels, but not with the monotherapy. None of hsCRP, MMP-9 or PGF levels was related with changes in PAs or TVAs in all vessels.
Conclusions: In patients with CAD, a long-term treatment with statin and AT1R blocker in combination may be more effective than statin alone in inhibiting atherosclerotic progression of the coronary arteries and aorta.