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CLINICAL RESEARCH: EFFECTS OF STATIN THERAPY

Changes in coronary plaque color and morphology by lipid-lowering therapy with atorvastatin: serial evaluation by coronary angioscopy

^* Department of Internal Medicine, Nippon Medical School, Chiba-Hokusoh Hospital, Imba, Chiba, Japan

Manuscript received October 16, 2002; revised manuscript received February 10, 2003, accepted February 20, 2003.

^* Reprint requests and correspondence: Dr. Kyoichi Mizuno, Department of Internal Medicine, Nippon Medical School, Chiba-Hokusoh Hospital, 1715 Kamakari, Imba, Chiba, Japan 270-1694.
mizunok{at}nms.ac.jp

OBJECTIVES: Changes in coronary plaque color and morphology by statin therapy were evaluated using coronary angioscopy.

BACKGROUND: Coronary plaque stabilization by statin therapy has not been clarified in humans.

METHODS: Thirty-one patients with coronary artery disease were divided into either the comparison group (n = 16) or the atorvastatin group (n = 15). Before treatment and 12 months after, the color and complexity of 145 coronary plaques were determined according to angioscopic findings. The yellow score of the plaque was defined as 0 (white), 1 (light yellow), 2 (yellow), or 3 (dark yellow), and its disrupted score was defined as 0 (smooth surface) or 1 (irregular surface) and as 0 (without thrombus) or 1 (with thrombus). In each patient, the mean yellow score and mean disrupted score were calculated.

RESULTS: Mean low-density lipoprotein cholesterol (LDL-C) decreased by 45% in the atorvastatin group, whereas an increase of 9% was seen in the comparison group. The mean yellow score decreased from 2.03 to 1.13 in the atorvastatin group, whereas it increased from 1.67 to 1.99 in the comparison group. There was a good correlation between the change in the mean yellow score and the change in LDL-C levels (r = 0.81, p < 0.0001). The change in the mean yellow score and mean disrupted score differed significantly between the two groups (p = 0.002 and p = 0.03, respectively).

CONCLUSIONS: This is the first report clarifying detailed changes in coronary plaque by statin in humans. This study indicated that lipid-lowering therapy changes plaque color and morphology and should then lead to coronary plaque stabilization.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CRP = C-reactive protein   HDL-C = high-density lipoprotein cholesterol   IMT = intima-media thickness   LDL-C = low-density lipoprotein cholesterol   MI = myocardial infarction   PCI = percutaneous coronary intervention   T-CHO = total cholesterol   TG = triglycerides

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