Elsevier

American Heart Journal

Volume 163, Issue 2, February 2012, Pages 191-199.e1
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Statin treatment for coronary artery plaque composition based on intravascular ultrasound radiofrequency data analysis

https://doi.org/10.1016/j.ahj.2011.11.004Get rights and content

Background

Systemic therapy with statin has been shown to lower the risk of coronary events; however, the in vivo effects of statin therapy on plaque volume and composition are less understood.

Methods

We conducted a prospective, open-labeled, randomized, multicenter study in 11 centers in Japan. A total of 164 patients were randomized to receive either 4 mg/d of pitavastatin (intensive lipid-lowering therapy) or 20 mg/d of pravastatin (moderate lipid-lowering therapy). Analyzable intravascular ultrasound data were obtained for 119 patients at baseline and at 8-month follow-up. The primary end point was the difference of volume changes in each of the 4 main plaque components (fibrosis, fibrofatty, calcium, and necrosis), assessed by virtual histology intravascular ultrasound, between the 2 groups.

Results

The mean low-density lipoprotein cholesterol level at follow-up was significantly lower in the pitavastatin than in the pravastatin group (74 vs 95 mg/dL, P < .0001). During the 8-month follow-up period, statin therapy reduced the absolute and relative amount of fibrofatty component (pitavastatin: from 1.09 to 0.81 mm3/mm, P = .001; pravastatin: from 1.05 to 0.83 mm3/mm, P = .0008) and increased in the amount of calcium (pitavastatin: from 0.42 to 0.55 mm3/mm, P < .0001; pravastatin: from 0.44 to 0.55 mm3/mm, P = .005), whereas volume changes in both plaque components were not statistically different between the 2 groups.

Conclusions

Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the fibrofatty plaque component and increasing the calcified plaque component.

Section snippets

Study design and ethical considerations

The TRUTH (treatment with statin on atheroma regression evaluated by IVUS with VH) study was a prospective, open-labeled, randomized, multicenter trial performed in 11 Japanese centers. The effects of pitavastatin and pravastatin on coronary artery plaque composition were assessed by VH-IVUS with 8 months of invasive follow-up.

The primary end point was the difference of volume changes in each of the 4 main plaque components measured by VH-IVUS between the 2 treatment groups. The secondary end

Patient populations

The study flow chart is shown in Figure 1. A total of 164 patients were enrolled; 82 patients were randomized to the pitavastatin group, and 82, to the pravastatin group. Intravascular ultrasound images qualifying for evaluation both at pretreatment and at follow-up were obtained in 58 patients (71%) in the pitavastatin group and 61 patients (74%) in the pravastatin group.

There were no significant differences in baseline characteristics between the 2 groups (Table I). The mean follow-up

Discussion

The main finding of the study was that both pitavastatin and pravastatin altered coronary artery plaque composition as assessed by VH-IVUS with a reduction of FF plaque component and increase of the calcified plaque component. Plaque progression occurs primarily because of increases in FI or FF components.13 In contrast to statin-induced plaque regression, these drugs may impact early stages of lipid accumulation, particularly the FF component.14, 15 Thus, the FF component may be a reversible

Conclusions

Both pitavastatin and pravastatin altered coronary artery plaque composition by significantly decreasing the FF component and increasing the DC component, whereas the volume changes in both plaque components were not statistically significant.

Disclosures

Funding Source: This study was supported by a grant from the Japan Heart Foundation.

Conflict of interest: None.

Acknowledgements

The authors acknowledge the contributions of Mr Yasuyoshi Suzuki and Mr Yoshiaki Nakayama in the IVUS core-laboratory management.

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