Abstract 13849: Impact of Statin-Ezetimibe Combination on Coronary Atheroma Progression/Regression in Patients With and Without Prior Statin Therapy - Subanalysis of PRECISE-IVUS Trial
Introduction: IMPROVE-IT trial showed the clinical benefit of statin-ezetimibe (EZE) combination appeared to be pronounced in patients with prior statin therapy. On the other hand, the PRECISE-IVUS (Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile.
Hypothesis: We hypothesized that the antiatherosclerotic effect of atorva-EZE combination was pronounced in patients with statin pretreatment.
Methods: 246 patients undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination or atorva alone. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients. We compared the IVUS endpoints in all subjects, stratified by the presence of statin pretreatment.
Results: The baseline LDL-C level (100.7±23.1mg/dL vs. 116.4±25.9mg/dL, p<0.001) and lathosterol (55 [38 to 87])μg/100mg TC vs. 97 [57 to 149]μg/100mg TC, p<0.001) was significantly lower, and campesterol/lathosterol ratio (3.9 [2.4 to 7.4] vs. 2.6 [1.5 to 4.1], p<0.001) was significantly accelerated in patients with statin pretreatment. Contrary to the patients without statin pretreatment (-1.3 [-3.1 to -0.1]% vs. -0.9 [-2.3 to 0.9]%, p=0.12), the atorva-EZE combination showed the significantly stronger reduction in delta percent atheroma volume, compared with atorva alone, in patients with statin pretreatment (-1.8 [-3.6 to -0.3]% vs. -0.1 [-1.6 to 0.8]%, p=0.002).
Conclusions: Compared to atorva alone, atorva-EZE combination demonstrated stronger regression effect in coronary atheroma volume especially in patients with statin pretreatment. Compensatory accelerated cholesterol absorption might be associated with reduced coronary plaque regression. Low-dose statin-EZE combination might be a promising option in statin-hyporesponder.
Author Disclosures: K. Tsujita: Speakers Bureau; Modest; Novartis Pharma K.K., Takeda Pharmaceutical Co., Ltd., Sanofi K.K., Pfizer Japan Inc, MSD K.K., Bristol-Myers Squibb Company, Daiichi Sankyo Co., Ltd.. Consultant/Advisory Board; Modest; Abbott Vascular, Boston Scientific, Terumo Corp., Volcano Corp.. K. Yamanaga: None. S. Sugiyama: None. H. Shimomura: None. T. Yamashita: None. K. Sakamoto: None. K. Nakao: None. S. Nakamura: None. M. Ishihara: Speakers Bureau; Modest; MSD. K. Matsui: None. N. Yamamoto: None. S. Koide: None. T. Matsumura: None. K. Fujimoto: None. R. Tsunoda: None. Y. Morikami: None. K. Matsuyama: None. S. Oshima: None. K. Kaikita: None. S. Hokimoto: None. H. Ogawa: Other Research Support; Modest; Astellas Pharma Inc, Bristol-Myers Squibb Company, Chugai Pharmaceutical Co, Ltd., Dainippon Sumitomo Pharma Co., Ltd., MSD K.K., Mochida Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Otsuka, Pfizer Japan Inc, Takeda Pharmaceutical Co., Ltd.. Other Research Support; Significant; Bayer, Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., Sanofi K.K.. Honoraria; Modest; AstraZeneca K.K., Boehringer Ingelheim Japan, Bristol-Myers Squibb Company, Mitsubishi Tanabe Pharma, Pfizer Japan Inc, Sanofi K.K., Teijin Pharma Co., Ltd. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K., Takeda Pharmaceutical Co., Ltd..
- © 2015 by American Heart Association, Inc.