Influence of a lipid-lowering therapy on calcified and noncalcified coronary plaques monitored by multislice detector computed tomography: results of the New Age II Pilot Study.
OBJECTIVE
Multislice detector computed tomography (MSCT) is an accurate noninvasive modality to detect and classify different stages of atherosclerosis. The aim of the New Age II Study was to detect coronary lesions in men without established coronary artery disease (CAD) but with a distinct cardiovascular risk profile. We also sought to assess the effect after 1 year of a lipid-lowering therapy (LLT) using 20 mg of atorvastatin.


METHODS
Forty-sixe male patients (mean, 61 +/- 10 years) with an elevated risk for CAD (PROCAM score >3 quintile) without LLT were included. Native and contrast-enhanced scans were performed in all patients. A total of 27 of 46 patients received a follow-up scan (after 488 +/- 138 days). Coronary plaque burden (CPB) was assessed volumetrically.


RESULTS
The prevalence of CAD was 83% (38/46 patients), and 11% (5/46) without coronary calcifications still had noncalcified plaques. Total cholesterol and low-density lipoprotein cholesterol levels decreased significantly under LLT (225 +/- 41 mg/dL vs. 162 +/- 37 mg/dL, P < 0.0001 and 148 +/- 7 mg/dL vs. 88 +/- 5 mg/dL, P < 0.001, respectively). On follow-up, calcium score and CPB remained unchanged (Agatston score: 261 +/- 301 vs. 282 +/- 360; CPB: 0.149 +/- 0.108 vs. 0.128 +/- 0.075 mL, P > 0.05), whereas mean plaque volume of noncalcified plaques decreased significantly from 0.042 +/- 0.029 mL versus 0.030 +/- 0.014 mL (P < 0.05, mean reduction 0.012 +/- 0.017 mL or 24 +/- 13%).


CONCLUSIONS
Statin therapy led to a significant reduction of noncalcified plaque burden that was not reflected in calcium scoring or total plaque burden. This finding might explain the risk reduction after the initiation of statin therapy. Using multislice detector computed tomography, physicians have the potential to monitor medical treatment in patients with coronary atherosclerosis.
Burgstahler
Christof
C
Department of Internal Medicine, Division of Cardiology, Eberhard-Karls-University, Tuebingen, Germany.
Reimann
Anja
A
Beck
Torsten
T
Kuettner
Axel
A
Baumann
Dorothee
D
Heuschmid
Martin
M
Brodoefel
Harald
H
Claussen
Claus D
CD
Kopp
Andreas F
AF
Schroeder
Stephen
S
D000328:Adult; D000368:Aged; D002114:Calcinosis / Q000188:drug therapy*; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000473:pathology; D003331:Coronary Vessels / Q000473:pathology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents