title: Comparison of Intensive Versus Moderate Lipid-Lowering Therapy on Fibrous Cap and Atheroma Volume of Coronary Lipid-Rich Plaque Using Serial Optical Coherence Tomography and Intravascular Ultrasound Imaging.
abstract: Despite marked clinical benefit, reduction in atheroma volume with statin therapy is minimal. Changes in plaque composition may explain this discrepancy. We aimed in the present study to assess the effect of statin therapy on coronary plaque composition and plaque volume using serial multimodality imaging. From an open-label, single-blinded study, patients with angiographically mild-to-moderate lesion were randomized to receive atorvastatin 60 (AT 60) mg or atorvastatin 20 (AT 20) mg for 12 months. Optical coherence tomography was used to assess fibrous cap thickness (FCT) and intravascular ultrasound to assess atheroma burden at 3 time points: baseline, at 6 months, and at 12 months. Thirty-six lipid-rich plaques in 27 patients with AT 60 mg and 30 lipid-rich plaques in 19 patients with AT 20 mg were enrolled in this study. Low-density lipoprotein cholesterol level was significantly decreased at 6 months without further reduction at 12 months. AT 60 mg induced greater reduction in low-density lipoprotein cholesterol compared with AT 20 mg. Optical coherence tomography revealed continuous increase in FCT from baseline to 6 months and to 12 months in both groups. AT 60 mg induced greater increase in FCT compared with AT 20 mg at both follow-up points. The prevalence of thin-cap fibroatheroma and the presence of macrophage at 6 months were significantly lower in AT 60 mg compared with AT 20 mg. Plaque burden did not change significantly in both groups. In conclusion, both intensive and moderate statin therapy stabilizes coronary plaques, with a greater benefit in the intensive statin group. However, no significant changes in plaque volume were observed over time regardless of the intensity of statin therapy.
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China; Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Lei
authors.initials: L
authors.lastname: Xing
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Jia
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Rocco
authors.initials: R
authors.lastname: Vergallo
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tsunerari
authors.initials: T
authors.lastname: Soeda
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Minami
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sining
authors.initials: S
authors.lastname: Hu
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shuang
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
authors.forename: Shaosong
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China. Electronic address: yubodr@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Yu
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Cardiology, Kyung Hee University, School of Medicine, Seoul, Korea.
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016037:Single-Blind Method; D041623:Tomography, Optical Coherence / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult
chemical_list: D000960:Hypolipidemic Agents; D008055:Lipids