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Comparison of Arterial Remodeling and Changes in Plaque Composition Between Patients With Progression Versus Regression of Coronary Atherosclerosis During Statin Therapy (from the TRUTH Study)

Published:February 13, 2012DOI:https://doi.org/10.1016/j.amjcard.2011.12.016
      Statin therapy produces regression of coronary artery plaques and reduces the incidence of coronary artery disease. However, not all patients show regression of coronary atherosclerosis after statin therapy. The purpose of the present study was to identify differences in clinical characteristics, serum lipid profiles, arterial remodeling, and plaque composition between patients with progression and those with regression of coronary atherosclerosis during statin therapy. The effects of 8-month statin therapy on coronary atherosclerosis were evaluated in the Treatment With Statin on Atheroma Regression Evaluated by Intravascular Ultrasound With Virtual Histology (TRUTH) study using intravascular ultrasound–virtual histology. One hundred nineteen patients were divided into 2 groups according to atheroma volume increase (progressors) or decrease (regressors) during an 8-month follow-up period. Fifty-one patients (43%) were categorized as progressors and the remaining 68 (57%) as regressors. External elastic membrane volume increased, although not significantly (0.8%, p = 0.34), and luminal volume decreased significantly (−5.3%, p = 0.0003) in progressors, while external elastic membrane volume decreased significantly (−3.2%, p <0.0001) and luminal volume increased (2.2%, p = 0.13) in regressors. The fibrous component increased significantly in progressors, while this component decreased in regressors. A strong positive correlation was observed between change in atheroma volume and change in fibrous volume (r = 0.812, p <0.0001). In conclusion, coronary arteries showed negative remodeling during statin-induced plaque regression. The difference in plaque composition between patients with progression and those with regression of coronary atherosclerosis during statin therapy arose from the difference in the change in fibrous component.
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      Linked Article

      • Statins, Plaque Regression, and Arterial Remodeling: Systemic Drug Effect, Local Effect, or a Combination Thereof?
        American Journal of CardiologyVol. 110Issue 2
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          We read with interest the study by Nozue et al,1 who investigated clinical and lesion-related factors associated with coronary plaque progression versus regression in statin-treated patients. The investigators reported that arteries showed increase in external elastic membrane (EEM) volume from baseline to follow-up (i.e., positive arterial remodeling) during plaque progression, as opposed to decrease in EEM volume (i.e., negative remodeling) during plaque regression.1 The study adds new insights to an important clinical issue, but it also raises a critical question: could the assessment of arterial remodeling be used to predict which statin-treated patients will subsequently develop plaque progression versus regression?
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