No data exist on the acute effects of statin therapy on human coronary atherosclerotic
plaques. The objective of our study was to evaluate the early (<2 months) effects
of newly initiated statin therapy on coronary atherosclerosis as evaluated by intravascular
ultrasonography. The study population consisted of 74 patients (mean age 58 ± 8 years)
who had been included in the ERASE trial (evaluating the effects of reconstituted
high-density lipoprotein infusions). All patients underwent serial intravascular ultrasonographic
(IVUS) evaluation at baseline (3 ± 2 days after an acute coronary syndrome [ACS])
and after 6 ± 1 weeks of follow-up. Statin therapy was initiated after ACS in 36 patients
who received ≤1 dose of statins before baseline IVUS examination (newly initiated
statin therapy group), and 38 patients were already on a stable statin dose before
the ACS (long-term statin therapy group). Atorvastatin at a dose of 40 mg/day was
the most common regimen in the 2 groups. Percent changes in atheroma volume (prespecified
primary efficacy parameter) were −4.71 ± 0.96% in the newly initiated statin therapy
group (p <0.0001) and −0.54 ± 0.89% in the long-term statin therapy group (p = 0.546;
p = 0.002 for comparison between groups). Median nominal changes in atheroma volume
were −9.10 mm3 (interquartile range −12.56 to −3.73, p <0.0001 vs baseline) and 1.21 mm3 (interquartile range −6.41 to 3.76, p = 0.429 vs baseline) in the newly initiated
and long-term statin therapy groups, respectively (p = 0.003 for comparison between
groups). Greater decreases in total cholesterol (r = 0.25, p = 0.035), ratio of total
to high-density lipoprotein cholesterol (r = 0.28, p = 0.018), and high-sensitivity
C-reactive protein (r = 0.31, p = 0.046, for patients with high-sensitivity C-reactive
protein measurements within 7 days after IVUS examination) were associated with larger
percent changes in atheroma volume. In conclusion, newly initiated statin therapy
is associated with rapid regression of coronary atherosclerosis within 2 months. This
effect was in part associated with decreases in atherogenic lipid and inflammatory
parameters. These results provide insight into the rapid clinical benefits of statin
therapy after an ACS.
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Article info
Publication history
Accepted:
May 5,
2009
Received in revised form:
May 5,
2009
Received:
February 12,
2009
Footnotes
This study was supported by the Cardiovascular Health Network of the Fonds de la Recherche en Santé du Québec, Montreal, Quebec, Canada. The ERASE trial was funded by CSL Ltd, Parkeville, Victoria, Australia.
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© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
