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CLINICAL RESEARCH: CARDIAC IMAGING

Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging

Atsushi Yonemura, MD^*, Yukihiko Momiyama, MD^*,*, Zahi A. Fayad, PhD, Makoto Ayaori, MD^*, Reiko Ohmori, PhD^*, Kenji Higashi, MD^*, Teruyoshi Kihara, MS, Shojiro Sawada, MD^*, Noriyuki Iwamoto, MD^*, Masatsune Ogura, MD^*, Hiroaki Taniguchi, MD^*, Masatoshi Kusuhara, MD^*, Masayoshi Nagata, MD, Haruo Nakamura, MD^*, Seiichi Tamai, MD^* and Fumitaka Ohsuzu, MD, FACC^*

^* National Defense Medical College, Saitama, Japan
Iruma Heart Hospital, Saitama, Japan
Mount Sinai School of Medicine, New York, New York

Manuscript received August 3, 2004; revised manuscript received October 15, 2004, accepted November 3, 2004.

^* Reprint requests and correspondence: Dr. Yukihiko Momiyama, First Department of Internal Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan (Email: momiyama{at}me.ndmc.ac.jp).

OBJECTIVES: We sought to elucidate the effects of 20-mg versus 5-mg atorvastatin on thoracic and abdominal aortic plaques.

BACKGROUND: Regression of thoracic aortic plaques by simvastatin was demonstrated using magnetic resonance imaging (MRI). However, the effects of different doses of statin have not been assessed.

METHODS: Using MRI, we investigated the effects of 20-mg versus 5-mg atorvastatin on thoracic and abdominal aortic plaques in 40 hypercholesterolemic patients who were randomized to receive either dose. Treatment effects were evaluated as changes in vessel wall thickness (VWT) and vessel wall area (VWA) of atherosclerotic lesions from baseline to 12 months of treatment.

RESULTS: The 20-mg dose induced a greater low-density lipoprotein (LDL) cholesterol reduction than did the 5-mg dose (–47% vs. –34%, p < 0.001). Although 20 mg and 5 mg reduced C-reactive protein (CRP) levels (–47% and –28%), the degree of CRP reduction did not differ between the two doses. The 20-mg dose reduced VWT and VWA of thoracic aortic plaques (–12% and –18%, p < 0.001), whereas 5 mg did not (+1% and +4%). Regarding abdominal aortic plaques, even 20 mg could not reduce VWT or VWA (–1% and +3%), but instead progression was observed with 5-mg treatment (+5% and +12%, p < 0.01). Notably, the degree of plaque regression in thoracic aorta correlated with LDL cholesterol (r = 0.64) and CRP (r = 0.49) reductions. Although changes in abdominal aortic plaques only weakly correlated with LDL cholesterol reduction (r = 0.34), they correlated with age (r = 0.41).

CONCLUSIONS: One-year 20-mg atorvastatin treatment induced regression of thoracic aortic plaques with marked LDL cholesterol reduction, whereas it resulted in only retardation of plaque progression in abdominal aorta. Thoracic and abdominal aortic plaques may have different susceptibilities to lipid lowering.

Abbreviations and Acronyms   hsCRP = high-sensitivity C-reactive protein   IMT = intima-media thickness   LA = lumen area   LDL = low-density lipoprotein   MRI = magnetic resonance imaging   PDW = proton density-weighted   T2W = T2-weighted   TVA = total vascular area   VWA = vessel wall area   VWT = vessel wall thickness

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