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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

View larger version (54K): [in a new window]   Figure 1 The magnetic resonance imaging (MRI) slices of aortas and morphometric analysis. At baseline, nine slices of the thoracic aorta were obtained at 12-mm intervals above the lower corner of the ninth thoracic vertebrae (arrow), and nine slices of the abdominal aorta were obtained at 12-mm intervals above the upper corner of the fourth lumbar vertebrae (arrow). After 12 months of treatment, three contiguous slices for each plaque were obtained. The slice most closely matching the one at baseline was selected. The lumen area and total vascular area were calculated from the traced luminal and outer wall boundaries.

View larger version (92K): [in a new window]   Figure 2 Images at baseline and after 12 months of treatment. After 12 months, three contiguous slices (no interslice gap) for each plaque were obtained, and the slice most closely matching the one at baseline was selected. In selected slices, arrows indicate plaques. (A) Thoracic aortic plaque that showed regression (28% vessel wall area [VWA] reduction) with 38% low-density lipoprotein-cholesterol (LDL-C) reduction by 20-mg atorvastatin; (B) thoracic plaque that showed regression (–10%) with 34% LDL-C reduction by 5 mg; (C) thoracic plaque that showed progression (+15%) with 20% LDL-C reduction by 5 mg; and (D) abdominal aortic plaque that showed progression (+9%) despite 39% LDL-C reduction by 20 mg.

View larger version (22K): [in a new window]   Figure 3 Correlations between the percent reduction in low-density lipoprotein-cholesterol (LDL-C) levels and the percent change in vessel wall area (VWA). The change in VWA in thoracic aortic plaques correlated well with the degree of LDL-C reduction (r = 0.64). A weak correlation was found in abdominal plaques (r = 0.34). Solid circles = 20-mg dose; open triangles = 5-mg dose.

View larger version (68K): [in a new window]   Figure 4 Images of thoracic aortic plaque with a lipid-rich core. This plaque had a hypointense region within the plaque on the T2-weighted (T2W) image at baseline. After 12 months, it showed regression (–8%) with a marked low-density lipoprotein-cholesterol (LDL-C) reduction (–56%). Arrows = plaques. Arrowhead = a lipid-rich core. PDW = protein density-weighted; VWA = vessel wall area.