Statin treatment for coronary artery plaque composition based on intravascular ultrasound radiofrequency data analysis.
BACKGROUND
Systemic therapy with statin has been shown to lower the risk of coronary events; however, the in vivo effects of statin therapy on plaque volume and composition are less understood.


METHODS
We conducted a prospective, open-labeled, randomized, multicenter study in 11 centers in Japan. A total of 164 patients were randomized to receive either 4 mg/d of pitavastatin (intensive lipid-lowering therapy) or 20 mg/d of pravastatin (moderate lipid-lowering therapy). Analyzable intravascular ultrasound data were obtained for 119 patients at baseline and at 8-month follow-up. The primary end point was the difference of volume changes in each of the 4 main plaque components (fibrosis, fibrofatty, calcium, and necrosis), assessed by virtual histology intravascular ultrasound, between the 2 groups.


RESULTS
The mean low-density lipoprotein cholesterol level at follow-up was significantly lower in the pitavastatin than in the pravastatin group (74 vs 95 mg/dL, P < .0001). During the 8-month follow-up period, statin therapy reduced the absolute and relative amount of fibrofatty component (pitavastatin: from 1.09 to 0.81 mm(3)/mm, P = .001; pravastatin: from 1.05 to 0.83 mm(3)/mm, P = .0008) and increased in the amount of calcium (pitavastatin: from 0.42 to 0.55 mm(3)/mm, P < .0001; pravastatin: from 0.44 to 0.55 mm(3)/mm, P = .005), whereas volume changes in both plaque components were not statistically different between the 2 groups.


CONCLUSIONS
Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the fibrofatty plaque component and increasing the calcified plaque component.
Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Japan. nozue2493@yahoo.co.jp
Tsuyoshi
T
Nozue
Shingo
S
Yamamoto
Shinichi
S
Tohyama
Shigeo
S
Umezawa
Tomoyuki
T
Kunishima
Akira
A
Sato
Shogo
S
Miyake
Youichi
Y
Takeyama
Yoshihiro
Y
Morino
Takao
T
Yamauchi
Toshiya
T
Muramatsu
Kiyoshi
K
Hibi
Takashi
T
Sozu
Mitsuyasu
M
Terashima
Ichiro
I
Michishita
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*; D017035:Pravastatin / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011804:Quinolines; D017035:Pravastatin; C108475:pitavastatin