title: Long-term treatment with low-dose metoprolol CR/XL is associated with increased plaque echogenicity: the Beta-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS).
abstract: OBJECTIVE
  To examine whether the decrease in IMT progression rate in the carotid bulb induced by metoprolol CR/XL treatment (25mg once daily) observed in the β-blocker Cholesterol-lowering Asymptomatic Plaque Study (BCAPS) was accompanied by an effect on carotid plaque echogenicity.
  
  
  METHODS
  Gray scale median (GSM) in carotid plaques, used as a score of echogenicity, was measured at baseline and after 36 months in those 341 subjects (aged 49-69 years) with an asymptomatic moderate- to large-sized carotid plaque present at baseline and at follow-up. Participants were in a factorial design assigned to treatment with metoprolol CR/XL (25mg once daily), fluvastatin (40 mg once daily) or corresponding placebo.
  
  
  RESULTS
  After 36 months plaques were more echogenic in participants treated compared to those not treated with metoprolol CR/XL (57.3 ± 16.8 versus 51.8 ± 20.0, p=0.006). GSM had increased more from baseline in the metoprolol CR/XL treated subjects (25 ± 15 versus 18 ± 20, p<0.001), and plaques that had become more echolucent were less frequent in the metoprolol CR/XL treated subjects (3.6% versus 17.0%, p<0.001).
  
  
  CONCLUSIONS
  Long-term treatment with low dose metoprolol CR/XL in clinically healthy subjects with moderate-sized carotid plaques was associated with increase in plaque echogenicity, suggesting a potential beneficial effect of the β-blocker treatment on plaque stability.
authors.affiliation: Department of Clinical Sciences, Malmö, Skåne University Hospital, Malmö, Sweden. Gerd.Ostling@med.lu.se
authors.forename: Gerd
authors.initials: G
authors.lastname: Ostling
authors.forename: Isabel
authors.initials: I
authors.lastname: Gonçalves
authors.forename: John
authors.initials: J
authors.lastname: Wikstrand
authors.forename: Göran
authors.initials: G
authors.lastname: Berglund
authors.forename: Jan
authors.initials: J
authors.lastname: Nilsson
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy; D004311:Double-Blind Method; D005229:Fatty Acids, Monounsaturated / Q000627:therapeutic use; D000077340:Fluvastatin; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D008790:Metoprolol / Q000008:administration & dosage*; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000473:pathology; D014463:Ultrasonography
chemical_list: D000319:Adrenergic beta-Antagonists; D005229:Fatty Acids, Monounsaturated; D007211:Indoles; D000077340:Fluvastatin; D008790:Metoprolol