title: Coronary atheroma volume and cardiovascular events during maximally intensive statin therapy.
abstract: OBJECTIVE
  The impact of baseline coronary plaque burden on the clinical outcome in patients receiving aggressive low-density lipoprotein cholesterol (LDL-C) lowering therapy to levels <70 mg/dL is unknown. We assessed the prognostic significance of baseline coronary plaque burden following high-intensity statin therapy.
  
  
  RESULTS
  SATURN used serial intravascular ultrasound (IVUS) to measure coronary atheroma volume in 1039 patients before and after 24 months of treatment with rosuvastatin 40 mg or atorvastatin 80 mg. This post hoc analysis compared the relationship between baseline percent atheroma volume (PAV) and major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, coronary revascularization, hospitalization for unstable angina) in patients with baseline PAV less than (n = 519) or greater than (n = 520) the median. Patients with a higher baseline PAV had a similar LDL-C compared with those with a lower baseline PAV at baseline (119.0 ± 29 vs. 121.0 ± 27 mg/dL, P = 0.09) and at follow-up (65.3 ± 23 vs. 65.8 ± 22 mg/dL, P = 0.47). In multivariable analysis, each standard deviation increase in baseline PAV was associated with a 28% increase in MACE [HR 1.28 (1.05, 1.57), P = 0.01]. Those with the highest quartile of baseline PAV (>41.8%) had a 2-year cumulative MACE rate of 12%, which was significantly higher (log-rank P = 0.001) than MACE rates of all lower PAV quartiles (MACE: quartile 3, 2, and 1 were 5.7, 7.9, and 5.1%, respectively). LDL-C levels at baseline [HR 0.96 (0.79, 1.18), P = 0.73] and on-treatment [HR 1.19 (0.83, 1.73), P = 0.35] were not associated with MACE.
  
  
  CONCLUSIONS
  Following 2 years of high-intensity statin therapy, a baseline coronary atheroma volume predicted MACE, despite the achievement of very low on-treatment LDL-C levels.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.forename: Mingyuan
authors.initials: M
authors.lastname: Shao
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Barter
authors.forename: M John
authors.initials: MJ
authors.lastname: Chapman
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.forename: Peter
authors.initials: P
authors.lastname: Libby
authors.forename: Joel S
authors.initials: JS
authors.lastname: Raichlen
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D000789:Angina, Unstable / Q000209:etiology; D000069059:Atorvastatin; D008078:Cholesterol, LDL / Q000378:metabolism; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality / Q000473:pathology*; D005260:Female; D005464:Fluorobenzenes / Q000008:administration & dosage*; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000401:mortality / Q000473:pathology*; D011743:Pyrimidines / Q000008:administration & dosage*; D011758:Pyrroles / Q000008:administration & dosage*; D000068718:Rosuvastatin Calcium; D020521:Stroke / Q000209:etiology; D013449:Sulfonamides / Q000008:administration & dosage*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D008078:Cholesterol, LDL; D005464:Fluorobenzenes; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D013449:Sulfonamides; D000068718:Rosuvastatin Calcium; D000069059:Atorvastatin
keywords: Atherosclerosis; Intravascular ultrasound; Statins