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J Am Coll Cardiol, 2007; 50:1520-1521, doi:10.1016/j.jacc.2007.06.036 (Published online 21 September 2007).
© 2007 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Eliminating Plaque Angiogenesis

Michael Koutouzis, MD and Zenon S. Kyriakides, MD, PhD*

* Director, B Cardiology Department, Red Cross Hospital, 1 Red Cross Str., Athens 115 26, Greece (Email: zskyr{at}otenet.gr).

We have read with great interest the article by Kolodgie et al. (1) focusing on elimination of intraplaque angiogenesis. It seems that neovascularization within the vessel wall plays an important role in plaque destabilization, and it is a determinant of vulnerability.

The beneficial effect of statins in patients with atherosclerotic disease is well established. This effect goes beyond lipid lowering, because statins also have other effects, which is why statins are considered pleiotropic. One of these is its effect on angiogenesis. We recently presented that patients on statin treatment have reduced intraplaque angiogenesis in their carotid endarterectomy specimens when compared with patients not receiving this kind of drug (2). This finding provides a new insight to the statins’ pathophysiologic mechanism of action. The fact that it was a cross-sectional, retrospective study without randomization cannot lead us to any causal conclusions about statins and intraplaque angiogenesis. However, there are strong indications favoring that hypothesis. Vascular endothelial growth factor is a well-recognized and potent angiogenetic factor. It is known that pravastatin, but also fenofibrate, reduces vascular endothelial growth factor plasma levels in humans (3).

These findings raise the question of whether statins are the antiangiogenetic factor for which we are searching. To answer this question, further investigation is needed, and maybe it is time for a randomized trial with standard dose and duration of treatment to test the effect on intraplaque angiogenesis.


   References
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 References
 

  1. Kolodgie FD, Narula G, Yuan C, Burke AP, Finn AV, Virmani R. Elimination of neoangiogenesis for plaque stabilization J Am Coll Cardiol 2007;49:2093-2101.[Abstract/Free Full Text]
  2. Koutouzis M, Nomikos A, Nikolidakis S, et al. Statin treated patients have reduced intraplaque angiogenesis in carotid endarterectomy specimens Atherosclerosis 2007;192:457-463.[CrossRef][ISI][Medline]
  3. Blann AD, Belgore FM, Constans J, Conri C, Lip GY. Plasma vascular endothelial growth factor and its receptor Flt-1 in patients with hyperlipidemia and atherosclerosis and the effects of fluvastatin or fenofibrate Am J Cardiol 2001;87:1160-1163.[CrossRef][ISI][Medline]

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Frank D. Kolodgie, Jagat Narula, Chun Yuan, Aloke V. Finn, Herman K. Gold, and Renu Virmani
J. Am. Coll. Cardiol. 2007 50: 1521. [Full Text] [PDF]




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