Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound.
10.3349/ymj.2016.57.5.1087
- Author:
Jung Hee LEE
1
;
Dong Ho SHIN
;
Byeong Keuk KIM
;
Young Guk KO
;
Donghoon CHOI
;
Yangsoo JANG
;
Myeong Ki HONG
Author Information
1. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. mkhong61@yuhs.ac
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Coronary artery disease;
coronary vessels;
ultrasonography;
cholesterol;
anticholesteremic agents
- MeSH:
Aged;
Cholesterol, LDL/*blood/drug effects;
Coronary Artery Disease/*diagnostic imaging;
Drug Administration Schedule;
Ezetimibe, Simvastatin Drug Combination/*administration & dosage;
Female;
Humans;
Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage;
Male;
Middle Aged;
Plaque, Atherosclerotic/*diagnostic imaging;
Pravastatin/administration & dosage;
Prospective Studies;
Time Factors;
Treatment Outcome;
Ultrasonography, Interventional
- From:Yonsei Medical Journal
2016;57(5):1087-1094
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: The effects of short-term intensive lipid-lowering treatment on coronary plaque composition have not yet been sufficiently evaluated. We investigated the influence of short-term intensive lipid-lowering treatment on quantitative and qualitative changes in plaque components of non-culprit lesions in patients with acute coronary syndrome. MATERIALS AND METHODS: This was a prospective, randomized, open-label, single-center trial. Seventy patients who underwent both baseline and three-month follow-up virtual histology intravascular ultrasound were randomly assigned to either an intensive lipid-lowering treatment group (ezetimibe/simvastatin 10/40 mg, n=34) or a control statin treatment group (pravastatin 20 mg, n=36). Using virtual histology intravascular ultrasound, plaque was characterized as fibrous, fibro-fatty, dense calcium, or necrotic core. Changes in plaque components during the three-month lipid-lowering treatment were compared between the two groups. RESULTS: Compared with the control statin treatment group, there was a significant reduction in low-density lipoprotein cholesterol in the intensive lipid-lowering treatment group (-20.4±17.1 mg/dL vs. -36.8±17.4 mg/dL, respectively; p<0.001). There were no statistically significant differences in baseline, three-month follow-up, or serial changes of gray-scale intravascular ultrasound parameters between the two groups. The absolute volume of fibro-fatty plaque was significantly reduced in the intensive lipid-lowering treatment group compared with the control group (-1.5±3.4 mm3 vs. 0.8±4.7 mm3, respectively; p=0.024). A linear correlation was found between changes in low-density lipoprotein cholesterol levels and changes in the absolute volumes of fibro-fatty plaque (p<0.001, R2=0.209). CONCLUSION: Modification of coronary plaque may be attainable after only three months of intensive lipid-lowering treatment.
