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Effects of Aggressive Versus Conventional Lipid-Lowering Therapy by Simvastatin on Human Atherosclerotic Lesions

A Prospective, Randomized, Double-Blind Trial With High-Resolution Magnetic Resonance Imaging

Roberto Corti, MD^_*,,1, Valentin Fuster, MD, PhD, FACC, Zahi A. Fayad, PhD, Stephen G. Worthley, MD^_*,, Gerard Helft, MD, PhD^_*,, William F. Chaplin, PhD, Jörg Muntwyler, MD¹, Juan F. Viles-Gonzalez, MD^_*,, Jesse Weinberger, MD, Donald A. Smith, MD, Gabor Mizsei, MSEE and Juan J. Badimon, PhD, FACC^_*,,_*

^_* Cardiovascular Biology Research Laboratory, Mount Sinai School of Medicine, New York, New York
Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
Department of Neurology, Mount Sinai School of Medicine, New York, New York

View larger version (22K): [in a new window]   Figure 1 Bar graph showing the effect of statin treatment on plasma low-density lipoprotein. Mean value of low-density lipoprotein cholesterol (LDL-C) during treatment and the pre-treatment value were used to calculate the changes. The bars describe the number of patients for a mean LDL-C at the end of treatment (A) and for the percent change in LDL-C (B). The line describes the distribution of the data. A significant decrease in LDL-C as compared with baseline was seen for both 20-mg and 80-mg simvastatin doses (A). The 80-mg simvastatin group is associated with a significantly greater 10% decline in LDL-C (B). Because of significantly higher baseline LDL-C values in the high-dose group, both groups ended in similar absolute values.

View larger version (25K): [in a new window]   Figure 2 Effect of statin treatment on plaque size. Bar graphs showing data on vessel wall area at baseline, 6, 12, 18, and 24 months for aorta (upper panel) and carotid artery (lower panel) for the 20 patients who reached the 24-month follow-up. Data are displayed according to the statin dose: simvastatin 20 mg (white bars) and 80 mg (black bars). Data are given as mean ± SEM.

View larger version (112K): [in a new window]   Figure 3 Representative cross-sectional magnetic resonance image of the same patient at baseline and at 24 months of statin treatment showing plaque regression at the level of the right carotid artery bifurcation. ICA = internal carotid artery; IJV = internal jugular vein.

View larger version (22K): [in a new window]   Figure 4 Effect of lipid lowering on plaque size according to the 100 mg/dl low-density lipoprotein cholesterol (LDL-C) goal. Changes in vessel wall area (VWA) are displayed according to the goal of 100 mg/dl (2.6 mmol/l). On treatment, LDL-C 100 mg/dl is associated with larger regression. Patients who reached the goal had a significantly higher regression in aortic lesions (left panel). A similar trend was seen for carotid lesions (right panel). The values of the last available magnetic resonance imaging examination and the baseline value were used to calculate percent changes in VWA.