Abstract 15100: Effect of Intensive versus Moderate Lipid-Lowering Therapy on Progression of Epicardial Adipose Tissue Volume in Hyperlipidemic Postmenopausal Women. A Substudy of the BELLES (Beyond Endorsed Lipid Lowering with EBT Scanning) Trial

Abstract

Background: The extent of epicardial adipose tissue (EAT) is associated with coronary artery disease severity and outcome. There is no knowledge of the change of EAT volume over time when patients are exposed to statin therapy.

Objectives: To evaluate the effect of intensive vs. moderate statin therapy on EAT.

Methods: 420 hyperlipidemic postmenopausal women, enrolled in a clinical trial designed to study the progression of coronary artery calcium (CAC) under lipid lowering treatment, were randomized to atorvastatin 80 mg/day (AT) or pravastatin 40 mg/day (PR) for one year. Patients underwent cardiac CT scans at the start and end of trial and percentage change in CAC, EAT and lipid fractions were calculated over the trial period.

Results: Of 420 patients 194 received AT and 226 PR. Baseline EAT correlated with age, body mass index, hypertension, diabetes mellitus, HDL and triglyceride levels and CAC (P <0.001). At the end of follow-up, EAT % change was greater in the AT than in the PR group (mean ± SD -3.1±11.24 vs. -0.98±11.69 in AT and PR treated patients, respectively; P=0.025). The EAT % change was significant within the AT, but not the PR group. Among the AT treated patients, the EAT % change was significantly correlated with % change in non-HDL and LDL levels (p=0.027 and 0.014, respectively). CAC progressed significantly in both groups (P <0.0001).

Conclusion: In hyperlipidemic, postmenopausal women, intensive statin therapy with atorvastatin induced a greater EAT regression compared to pravastatin. The regression appeared linked with the effectiveness of lipid reduction.