title: Virtual histology evaluation of atherosclerosis regression during atorvastatin and ezetimibe administration: HEAVEN study.
abstract: BACKGROUND
  There is no study focusing on changes in coronary atherosclerosis during dual lipid-lowering therapy with statin and ezetimibe.
  
  
  RESULTS
  Eighty-nine patients with stable angina randomized in a 1:1 ratio to Group A (aggressive therapy: atorvastatin 80mg, ezetimibe 10mg) and Group S (standard therapy) were analyzed. Treatment period was 12 months. Coronary arteries were examined by intravascular ultrasound and virtual histology. We found a decrease in the percent atheroma volume (PAV) (-0.4%) in Group A compared with an increase (+1.4%) in Group S (P=0.014) and this was accompanied by an increased frequency of combined atherosclerosis regression (increased lumen volume+decreased PAV) in group A (40.5%) compared with group S (14.9%) (P=0.007). The target low-density lipoprotein cholesterol level <2mmol/L, presence of at least 4 of 5 atherosclerotic risk factors, and decreased level of vascular cellular adhesive molecule were independent predictors of plaque regression. There were no significant differences in plaque composition between the 2 groups over the study duration. However, during analysis of the 2 groups together, fibrous and fibro-fatty tissues decreased and dense calcification and necrotic core increased during follow-up.
  
  
  CONCLUSIONS
  Dual lipid-lowering therapy starts atherosclerosis regression, but does not lead to significant changes in plaque composition. The continuous shift in plaque from fibro and fibro-fatty to necrotic with calcification was present in both groups.
authors.affiliation: 2nd Department of Medicine, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. tomas.kovarnik@vfn.cz
authors.forename: Tomas
authors.initials: T
authors.lastname: Kovarnik
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Hana
authors.initials: H
authors.lastname: Skalicka
authors.forename: Ales
authors.initials: A
authors.lastname: Kral
authors.forename: Jan
authors.initials: J
authors.lastname: Horak
authors.forename: Roman
authors.initials: R
authors.lastname: Skulec
authors.forename: Jana
authors.initials: J
authors.lastname: Uhrova
authors.forename: Pavel
authors.initials: P
authors.lastname: Martasek
authors.forename: Richard W
authors.initials: RW
authors.lastname: Downe
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahle
authors.forename: Milan
authors.initials: M
authors.lastname: Sonka
authors.forename: Vratislav
authors.initials: V
authors.lastname: Mrazek
authors.forename: Michael
authors.initials: M
authors.lastname: Aschermann
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D001384:Azetidines / Q000627:therapeutic use*; D015815:Cell Adhesion Molecules / Q000378:metabolism; D002784:Cholesterol / Q000378:metabolism; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D000069438:Ezetimibe; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D008074:Lipoproteins / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D011758:Pyrroles / Q000627:therapeutic use*; D016037:Single-Blind Method; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D015815:Cell Adhesion Molecules; D006538:Heptanoic Acids; D008074:Lipoproteins; D011758:Pyrroles; C030104:lipoprotein cholesterol; D002784:Cholesterol; D000069059:Atorvastatin; D000069438:Ezetimibe