title: Comparison of atorvastatin 5 and 20 mg/d for reducing F-18 fluorodeoxyglucose uptake in atherosclerotic plaques on positron emission tomography/computed tomography: a randomized, investigator-blinded, open-label, 6-month study in Japanese adults scheduled for percutaneous coronary intervention.
abstract: BACKGROUND
  F-18 fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) is a useful tool for the detection of local inflamed atherosclerotic lesions.
  
  
  OBJECTIVE
  This study used hybrid PET/computed tomography (CT) to examine the effects of 2 doses of atorvastatin on (18)F-FDG uptake in atherosclerotic plaques in Japanese adults with stable angina pectoris who were scheduled to undergo percutaneous coronary intervention (PCI).
  
  
  METHODS
  This was a prospective, randomized, investigator-blinded, open-label study in patients with dyslipidemia (total cholesterol ≥ 220 mg/dL and/or LDL-C ≥ 140 mg/dL) who were scheduled to undergo PCI for stable angina pectoris and had not received any lipid-lowering drugs within 1 year before enrollment. Patients were randomly allocated to receive atorvastatin 5 or 20 mg/d for 6 months. At baseline (the day after PCI), (18)F-FDG uptake in the ascending aorta and femoral artery was determined using PET/CT imaging, and the mean target-to-background ratio (TBR) was calculated in individual plaques. The same regions were assessed by PET/CT after 6 months of treatment. Changes from baseline to follow-up in the lipid profile, serum malondialdehyde-modified LDL-C (MDA-LDL-C), and serum high-sensitivity C-reactive protein (hs-CRP) were also examined. Drug adherence, adverse events, and changes in medications were monitored at monthly outpatient visits.
  
  
  RESULTS
  Of 32 patients initially screened, 2 were excluded due to newly diagnosed cancer; thus, 30 patients were randomly assigned to treatment, 15 in each group. Patients were predominantly male (18 [60%]), with a mean (SD) age of 54 (11) years, mean body weight of 65 (12) kg, and mean total cholesterol, HDL-C, and triglyceride concentrations of 240 (29), 48 (14), and 180 (102) mg/dL, respectively. After 6 months, the 20-mg group had significant reductions from baseline in mean (SD) TBR in the ascending aorta (from 1.15 [0.14] to 1.05 [0.12]; percent change, -7.9% [9.4%]; P = 0.007) and the femoral artery (from 1.12 [0.11] to 1.02 [0.11]; percent change, -9.9% [13.8%]; P = 0.012). The corresponding changes from baseline were not statistically significant in the 5-mg group. The differences in percent change in TBR in the 2 locations were not significant between groups. When data from the 2 groups were combined, the overall reduction in TBR from baseline to 6 months was significant in both the ascending aorta (P = 0.003) and the femoral artery (P = 0.021). The decreases in TBR in both arteries were significantly correlated with reductions in LDL-C (ascending aorta: r(2) = 0.230 [P = 0.012]; femoral artery: r(2) = 0.338 [P = 0.003]), MDA-LDL-C (ascending aorta: r(2) = 0.183 [P = 0.028]; femoral artery: r(2) = 0.247 [P = 0.010]), and hs-CRP (ascending aorta: r(2) = 0.132 [P = 0.048]; femoral artery: r(2) = 0.271 [P = 0.007]). One patient in the 5-mg group and 2 patients in the 20-mg group had ∼2-fold increases in serum aminotransferases on a single occasion; however, no specific musculoskeletal or hepatic adverse events were observed, and aminotransferase values decreased to within normal ranges without changes in the atorvastatin dose.
  
  
  CONCLUSIONS
  Six months of treatment with atorvastatin 20 mg, but not 5 mg, was associated with a significant reduction in TBR in the ascending aorta and femoral artery in these Japanese adults with dyslipidemia undergoing PCI for stable angina pectoris. University Hospital Medical Information Network Clinical Trials Registry identifier: C000000371.
authors.affiliation: Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. hkishii@med.nagoya-u.ac.jp
authors.forename: Hideki
authors.initials: H
authors.lastname: Ishii
authors.forename: Masami
authors.initials: M
authors.lastname: Nishio
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Toru
authors.initials: T
authors.lastname: Aoyama
authors.forename: Miho
authors.initials: M
authors.lastname: Tanaka
authors.forename: Takanobu
authors.initials: T
authors.lastname: Toriyama
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Tamaki
authors.forename: Daiji
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Mutsuharu
authors.initials: M
authors.lastname: Hayashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Amano
authors.forename: Tatsuaki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Toyoaki
authors.initials: T
authors.lastname: Murohara
mesh_terms: D000787:Angina Pectoris / Q000150:complications / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001011:Aorta / Q000000981:diagnostic imaging / Q000378:metabolism; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000069059:Atorvastatin; D004305:Dose-Response Relationship, Drug; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy / Q000378:metabolism; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000378:metabolism; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D011758:Pyrroles / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D011758:Pyrroles; D019788:Fluorodeoxyglucose F18; D000069059:Atorvastatin