title: Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic coarctation?
abstract: BACKGROUND
  Carotid intima-media thickness (CIMT) is a marker for atherosclerosis. Adult post-coarctectomy patients (CoA) demonstrate an increased cardiovascular risk and increased CIMT compared to controls. This study evaluates the effect of high dose statins on the change in CIMT and cardiovascular risk.
  
  
  METHODS
  We designed a multicenter, prospective, randomized, open label trial with blinded endpoint (PROBE design) to evaluate the effect of three year treatment with atorvastatin 80 mg on CIMT and cardiovascular risk. Primary endpoint was CIMT measured by B mode ultrasonography. Secondary endpoints were mortality and morbidity due to cardiovascular disease and serum lipids.
  
  
  RESULTS
  155 patients (36.3 ± 11.8 years, 96 (62%) male) were randomized (atorvastatin=80, no treatment=75). There was no significant effect of atorvastatin on the change in CIMT (treatment effect -0.005, 95% CI, -0.039-0.029; P=0.76). A significant effect on serum cholesterol and LDL levels was found (- 0.71, 95% CI, - 1.16 to - 0.26; P = 0.002 vs - 0.66, 95% CI - 1.06 to - 0.26; P = 0.001). There was no difference in secondary outcome measures. Baseline CIMT was higher in hypertensive compared to normotensive CoA. (0.69 ± 0.16 mm vs 0.61 ± 0.98 mm; P=0.002). Hypertension (ß=0.043, P=0.031) was the strongest determinant CIMT.
  
  
  CONCLUSIONS
  Three year treatment with atorvastatin does not lead to a reduction of CIMT and secondary outcome measures, despite a decrease in total cholesterol and LDL levels. Hypertensive CoA demonstrate the highest CIMT and the largest CIMT progression. Blood pressure control should be the main focus in CoA to decrease cardiovascular risk.
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Luijendijk
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: B J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Haga Hospital, The Hague, The Netherlands.
authors.forename: J W J
authors.initials: JW
authors.lastname: Vriend
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Groenink
authors.affiliation: Department of Cardiology, Leiden Medical Center, Leiden, The Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: de Groot
authors.affiliation: Department of Cardiology, University Medical Center Groningen, The Netherlands.
authors.forename: P G
authors.initials: PG
authors.lastname: Pieper
authors.affiliation: Department of Cardiology, Radboud University Medical Center, The Netherlands.
authors.forename: A P J
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, The Netherlands.
authors.forename: G T
authors.initials: GT
authors.lastname: Sieswerda
authors.affiliation: Department of Cardiology, VU University Medical Center, Medical Center, The Netherlands.
authors.forename: T C
authors.initials: TC
authors.lastname: Konings
authors.affiliation: Department of Vascular Medicine, Academic Medical Center Amsterdam, The Netherlands.
authors.forename: E S
authors.initials: ES
authors.lastname: Stroes
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A H
authors.initials: AH
authors.lastname: Zwinderman
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. Electronic address: b.j.mulder@amc.uva.nl.
authors.forename: B J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000328:Adult; D001017:Aortic Coarctation / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy*; D004730:Endothelium, Vascular / Q000187:drug effects* / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Aortic coarctation; Atherosclerosis; Cardiovascular risk; Carotid intima media thickness; Statins