Effects of statins on progression of carotid atherosclerosis as measured by carotid intimal--medial thickness: a meta-analysis of randomized controlled trials.
BACKGROUND
Carotid intimal-medial thickness (CIMT) as measured by B-mode ultrasonography is a surrogate marker for carotid atherosclerosis. Studies have found conflicting results for the effect of statins on carotid atherosclerosis progression by measuring CIMT. Hence, this meta-analysis was conducted to evaluate the impact of statin therapy on CIMT progression.


METHODS
A systematic search using PubMed, EMBASE, and Cochrane library databases was performed. Heterogeneity of the studies was analyzed by the Cochran Q statistics. The significance of common treatment effect was assessed by computing common mean difference between the control and treatment groups. A 2-sided alpha error of less than 0.05 was considered to be statistically significant.


RESULTS
In all, 11 trials (N = 3806) fulfilled the criteria for inclusion in the analysis. The study population included 67.2% males and 22.8% females. The mean age was 58.7 years. Treatment with statins (mean treatment duration of 25.6 months) resulted in a significant reduction in the mean low-density lipoprotein ([LDL]; mg/dL, before treatment 168.6 ± 33.3, after treatment 102.33 ± 27.9, P < .05). No significant changes in the levels of LDL cholesterol were noted in the control group. A total of 7 trials showed regression and 4 trials showed slowing of progression of CIMT. Pooled analysis of all 11 trials showed that there was a statistically significant benefit with statin therapy in slowing down the progression of CIMT and the common mean difference between statin therapy arm and placebo arm was -0.040 (CI: -0.052--0.028; P value < .001).


CONCLUSIONS
Statins therapy slows down the progression of carotid atherosclerosis as measured by CIMT, indicating benefits at subclinical stage of the disease process.
Bedi
Updesh Singh
US
Division of Cardiology, Department of Medicine, The Chicago Medical School, North Chicago, IL, USA. bediupdesh@gmail.com
Singh
Mukesh
M
Singh
Param Puneet
PP
Bhuriya
Rohit
R
Bahekar
Amol
A
Molnar
Janos
J
Khosla
Sandeep
S
Arora
Rohit
R
D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D008078:Cholesterol, LDL / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000187:drug effects*; D014463:Ultrasonography
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors