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CLINICAL RESEARCH: CARDIAC IMAGING

Simvastatin Attenuates Plaque Inflammation

Evaluation by Fluorodeoxyglucose Positron Emission Tomography

Nobuhiro Tahara, MD, PhD^_*, Hisashi Kai, MD, PhD^_*,_*, Masatoshi Ishibashi, MD, PhD, Hiroyuki Nakaura, MD, PhD^_*, Hayato Kaida, MD, Kenkichi Baba, MD, Naofumi Hayabuchi, MD, PhD and Tsutomu Imaizumi, MD, PhD^_*

^_* Department of Medicine/Cardiovascular Research Institute, Division of Cardio-Vascular Medicine
Department of Radiology, Kurume University School of Medicine, Kurume, Japan

Manuscript received January 10, 2006; revised manuscript received March 3, 2006, accepted March 6, 2006.

^_* Reprint requests and correspondence: Dr. Hisashi Kai, Department of Medicine/Cardiovascular Research Institute, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. (Email: naikai{at}med.kurume-u.ac.jp).

OBJECTIVES: We investigated whether simvastatin attenuates plaque inflammation by using ¹⁸ F-fluorodeoxyglucose positron emission tomography (¹⁸ FDG-PET) co-registered with computerized tomography.

BACKGROUND: Inflammation plays a key role in progression and destabilization of atherosclerotic plaque. ¹⁸ F-fluorodeoxyglucose PET is a promising tool for visualizing inflammation of atherosclerotic plaque. Antiinflammatory action is one of the pleiotropic effects of statins.

METHODS: Forty-three consecutive subjects, who underwent ¹⁸ FDG-PET for cancer screening and had ¹⁸ FDG uptakes in the thoracic aorta and/or the carotid arteries, were randomized to either statin group receiving simvastatin (n = 21) or diet group receiving dietary management only (n = 22). The maximum standardized uptake values (SUVs) were measured in individual plaques, and were averaged for analysis of the subjectwise results. The responses were assessed after 3-month treatments.

RESULTS: Positron emission tomography revealed 117 and 123 ¹⁸ FDG-positive plaques in the statin and diet groups, respectively. Simvastatin, but not diet alone, attenuated plaque ¹⁸ FDG uptakes and decreased the SUVs (p < 0.01). Simvastatin reduced low-density lipoprotein cholesterol (LDL-C) by 30% (p < 0.01) and increased high-density lipoprotein cholesterol (HDL-C) by 15% (p < 0.01), whereas LDL-C and HDL-C levels were not changed in the diet group. In the statin group, the decrease in the SUV was well correlated with the HDL-C elevation (p < 0.01) but not with the LDL-C reduction.

CONCLUSIONS: ¹⁸ F-fluorodeoxyglucose PET visualized plaque inflammation and simvastatin attenuated it. The LDL-C–independent effects of simvastatin may participate in the beneficial effect. ¹⁸ F-fluorodeoxyglucose PET has a potential for visually monitoring plaque inflammation and the therapeutic effectiveness of statins.

Abbreviations and Acronyms   18 FDG = 18 F-fluorodeoxyglucose   CT = computed tomography   HDL-C = high-density lipoprotein cholesterol   hsCRP = high-sensitivity C-reactive protein   LDL-C = low-density lipoprotein cholesterol   MRI = magnetic resonance imaging   PET = positron emission tomography

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J. Am. Coll. Cardiol. 2006 48: 1818-1824. [Abstract] [Full Text] [PDF]

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