More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome--sub-analysis of JAPAN-ACS study.
OBJECTIVE
We have shown that aggressive lipid lowering by pitavastatin and atorvastatin results in marked regression of atherosclerotic coronary lesions after acute coronary syndrome (ACS). The purpose of this study was to address the association of lipid levels after statin therapy with regression of atherosclerotic coronary lesions and major cardiovascular events in patients after ACS.


METHODS
JAPAN-ACS is a prospective, randomized open-label study performed at 33 centers in Japan. Patients with ACS undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) were randomly assigned to receive either 4 mg/day pitavastatin or 20 mg/day atorvastatin within 72 hours after PCI. IVUS image was obtained in 251 patients, including 73 diabetic patients. Lipid profiles at the end of the study were divided into quartiles and the association with the percent change in non-culprit coronary plaque volume (PV) was assessed in total and diabetic patients. We also studied whether baseline and follow-up levels of HDL-cholesterol are associated with restenosis after PCI.


RESULTS
Decreasing LDL-cholesterol, non-HDL-cholesterol, LDL-C/HDL-C ratio, apolipoprotein B quartiles were associated with a progressively smaller plaque burden in total and diabetic patients. In diabetic patients, further reduction of these parameters was associated with a significantly greater reduction in PV. We also found that patients with lower HDL-cholesterol had a significantly higher incidence of target lesion revascularization.


CONCLUSIONS
Early intensive statin therapy in patients after ACS results in remarkable regression of coronary PV. Diabetic patients can have a benefit with more intensive therapy to achieve a lower target level in Japanese.
Arai
Hidenori
H
Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. harai@kuhp.kyoto-u.ac.jp
Hiro
Takafumi
T
Kimura
Takeshi
T
Morimoto
Takeshi
T
Miyauchi
Katsumi
K
Nakagawa
Yoshihisa
Y
Yamagishi
Masakazu
M
Ozaki
Yukio
Y
Kimura
Kazuo
K
Saito
Satoshi
S
Yamaguchi
Tetsu
T
Daida
Hiroyuki
H
Matsuzaki
Masunori
M
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D000368:Aged; D000069059:Atorvastatin; D008076:Cholesterol, HDL / Q000378:metabolism; D008078:Cholesterol, LDL / Q000378:metabolism; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D048909:Diabetes Complications / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007564:Japan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D011804:Quinolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D011804:Quinolines; D000069059:Atorvastatin; C108475:pitavastatin