title: Atorvastatin treatment and carotid plaque morphology in first-ever atherosclerotic transient ischemic attack/stroke: a case-control study.
abstract: BACKGROUND
  A relationship between echolucency of carotid plaques and the consequent risk of ipsilateral ischemic stroke has been observed. An aggressive lipid-lowering therapy may increase the echogenicity of carotid plaque in patients with elevated low-density lipoprotein cholesterol levels. The aim of this study is to prospectively evaluate the long-term effect of high-dose atorvastatin on carotid plaque morphology in patients with first-ever transient ischemic attack or stroke.
  
  
  METHODS
  All patients with symptomatic first ischemic atherosclerotic cerebrovascular event occurred within the previous 10 days were enrolled. Carotid Doppler ultrasound of the neck vessels with 7-11 MHz probe for the definition of the atherosclerotic carotid framework was performed. The analysis of the gray-scale median (GSM) of each plate was carried out with image processing software.
  
  
  RESULTS
  A total of 240 symptomatic plaques were included and divided into 3 groups: 80 in group A (atorvastatin 80 mg), 80 in group B (atorvastatin 40 mg), and 80 to group C (no atorvastatin). GSM score increases significantly more extensive in group A than in group B (+48.65 vs. +39.46, P < .02) and group C (+48.65 vs. 19.3, P = .0002). An inverse association between reduction of low-density lipoprotein and the increase in the GSM score (r = -.456, P = .007) has been observed. Moreover, the reduction of high-sensitive C-reactive protein correlates inversely with the increase of the GSM (r = -.398, P = .021).
  
  
  CONCLUSIONS
  Dose-dependent effect of atorvastatin on symptomatic carotid plaque morphology may suggest a specific role of this drug in the atherosclerotic stroke prevention.
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy; Operative Unit of Neurology, Department of Clinical Neurosciences, Neurological Center of Latium, Rome, Italy. Electronic address: docpask@yahoo.com.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Marchione
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Vento
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Morreale
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy; Operative Unit of Neurology, Department of Clinical Neurosciences, Neurological Center of Latium, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Izzo
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Maugeri
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Manuppella
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Romeo
authors.affiliation: Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Giacomini
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006538:Heptanoic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology*; D011446:Prospective Studies; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000188:drug therapy* / Q000473:pathology*; D014463:Ultrasonography
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin
keywords: Atorvastatin; carotid plaque; carotid stenosis; carotid ultrasound; gray-scale median; stroke