title: Statin treatment, carotid atherosclerotic plaque macrophage infiltration and circulating inflammatory markers.
abstract: BACKGROUND
  Statin treatment is considered as first line therapy in patients with atherosclerotic disease. We evaluated the effect of pre-treatment with statins on carotid plaque infiltration by macrophages and on the circulating levels of proinflammatory cytokines in patients who underwent carotid endarterectomy.
  
  
  METHODS
  One hundred fourteen patients were enrolled; 89 men and 25 women (mean age 67+/-8 years; range 42-83 years). Fifty three patients (46%) were on statin treatment at least 3 months before endarterectomy and 61 (54%) had never received statin treatment. The serum levels of high sensitivity C reactive protein (hsCRP), serum amyloid A (SAA), tumor necrosis factor alpha (TNFalpha), interleukin (IL)-1beta and IL-6 were evaluated preoperatively. The intensity of macrophage infiltration was evaluated by immunochemistry, using the monoclonal antibody CD 68. The area of the plaque covered by macrophages was measured as a proportion of the whole plaque area, using a custom designed image tool analysis.
  
  
  RESULTS
  Patients on statins had lower serum total cholesterol levels (172+/-50 vs 194+/-35 mg/dl, p= 0.014), lower low density cholesterol levels (103+/-44 vs 123+/-31 mg/dl, p= 0.010) and lower serum hsCRP levels (1.8 [1.1-3.4] vs 3.4 [1.3-4.9] mg/l, p= 0.03), while SAA, TNFalpha, IL-6 and IL-1beta levels did not differ between the 2 groups. The infiltration of atherosclerotic plaque by macrophages was similar in statin treated patients and in controls (0.55+/-0.15% vs 0.49+/-0.19%, p= 0.21).
  
  
  CONCLUSIONS
  Patients on statins have similar macrophage accumulation in their carotid atherosclerotic plaques compared with patients not on statins. Inflammatory markers were also similar in both groups except for hsCRP which was significantly lower in those taking statins.
authors.affiliation: 2nd Department of Cardiology, Red Cross Hospital, Athens, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Koutouzis
authors.forename: Kosmas I
authors.initials: KI
authors.lastname: Paraskevas
authors.forename: Loukianos S
authors.initials: LS
authors.lastname: Rallidis
authors.forename: Calypso
authors.initials: C
authors.lastname: Barbatis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Nomikos
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Tzavara
authors.forename: Maria
authors.initials: M
authors.lastname: Tsopanomichalou
authors.forename: Christos
authors.initials: C
authors.lastname: Lioupis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bessias
authors.forename: Vassilios
authors.initials: V
authors.lastname: Andikopoulos
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Zenon S
authors.initials: ZS
authors.lastname: Kyriakides