Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques: a 2-year follow-up by noninvasive MRI.
BACKGROUND
Using MRI, we reported plaque regression in thoracic aorta and retardation of plaque progression in abdominal aorta by 1-year atorvastatin. However, association between serial plaque changes and LDL-cholesterol levels was not fully elucidated.


METHODS
A prospective, randomized, open-label trial.


METHODS
We investigated the long-term effect of 20 versus 5-mg atorvastatin on thoracic and abdominal plaques and the association between plaque progression and on-treatment LDL-cholesterol levels in 36 hypercholesterolemic patients. MRI was performed at baseline and 1 and 2 years of treatment. Vessel wall area change was evaluated.


RESULTS
The 20-mg dose markedly reduced LDL-cholesterol levels (-47%) versus 5-mg (-35%) dose. After 2 years of treatment, regression of thoracic plaques was found in the 20-mg group (-15% vessel wall area reduction), but not in the 5-mg group (+7%). Although the 20-mg dose induced plaque regression (-14%) from baseline to 1 year, no further regression was seen from 1 to 2 years of treatment (-1%). Regarding abdominal plaques, progression was found in the 5-mg group (+10%), but not in the 20-mg group (+2%). Plaque progression in the 5-mg group was found from baseline to 1 year (+8%), but not from 1 to 2 years (+2%). The degree of thoracic plaque regression correlated with LDL-cholesterol reduction (r = 0.61), whereas thoracic plaque change from 1 to 2 years correlated with on-treatment LDL-cholesterol levels (r = 0.64).


CONCLUSIONS
Twenty milligrams of atorvastatin regressed thoracic plaques. However, maintaining low LDL-cholesterol levels was needed to prevent plaque progression. In abdominal aorta, only retardation of plaque progression was found after 2 years of 20-mg treatment.
Yonemura
Atsushi
A
National Defense Medical College, Tokyo, Japan.
Momiyama
Yukihiko
Y
Fayad
Zahi A
ZA
Ayaori
Makoto
M
Ohmori
Reiko
R
Kihara
Teruyoshi
T
Tanaka
Nobukiyo
N
Nakaya
Kazuhiro
K
Ogura
Masatsune
M
Taniguchi
Hiroaki
H
Kusuhara
Masatoshi
M
Nagata
Masayoshi
M
Nakamura
Haruo
H
Tamai
Seiichi
S
Ohsuzu
Fumitaka
F
D000368:Aged; D001012:Aorta, Abdominal / Q000187:drug effects* / Q000473:pathology; D001013:Aorta, Thoracic / Q000187:drug effects* / Q000473:pathology; D001018:Aortic Diseases / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D001027:Aortography / Q000379:methods*; D050197:Atherosclerosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin