Abstract 12315: Morphologic and Anti-inflammatory Effect of a Strong Lipophilic or Mild Hydrophilic Statin on Atherosclerotic Plaque in the Thoracic Aorta: Assessment by Integrated Backscatter Transesophageal Echocardiography and PET/CT in a Prospective, Randomized Study

Abstract

Background: There are few studies that examined both the morphologic and anti-inflammatory effects of strong lipophilic and mild hydrophilic statins on atherosclerotic plaques. We sought to compare the effect of a strong lipophilic statin (pitavastatin) with a mild hydrophilic statin (pravastatin) on plaque components and morphology in the thoracic aorta assessed by transesophageal echocardiography (TEE), and on plaque inflammation determined by 18F-FDG PET/CT.

Methods: Patients with dyslipidemia were randomly divided into two treatment groups: a pitavastatin (PI) group (2 mg/day, n=15, 69±5 years old) and a pravastatin (PR) group (10 mg/day, n=14, 69±6 years old). We examined atherosclerotic plaques in the thoracic aorta by TEE and 18F-FDG PET/CT. Intima-media thickness (IMT) and corrected integrated backscatter values (cIBS) in the intima-media complex were measured by TEE, and maximum standard uptake values (SUVmax) were measured by 18F-FDG PET/CT at baseline and after six months of statin therapy. We calculated the target-to-background ratio (TBR) to measure SUVmax of plaques and evaluated the percent change of TBR.

Results: There were no significant differences in LDL cholesterol, TBR, IMT and cIBS at baseline between the two groups. After statin treatment, LDL cholesterol decreased by 50% in the PI group and 28% in PR group (p<0.01). Furthermore, the percent change of TBR was significantly greater in the PI group than in the PR group (-14.0±12.9% vs. -2.1±15.0%, respectively; p<0.01). The IMT of the thoracic aorta in the PI group was significantly reduced from 2.7±1.0 to 2.3±0.8 mm (p<0.01), but that in the PR group was not reduced (3.0±0.7 vs. 3.3±0.6 mm). The cIBS in the PI group increased significantly from -17±4 to -14±3 dB, but there was no significant change in the PR group.

Conclusion: Pitavastatin improved not only atherosis measured by IMT and cIBS, but also plaque inflammation measured by SUVmax in the same lesions, indicating more regression and stabilization of plaques in the thoracic aorta compared with a mild hydrophilic statin.