| Objective Previous studies showed the potential effect of intense lipid-lowering therapy(LLT) on the regression of coronary atherosclerosis in defined patient subgroups. No data on the change of plaque contents followed by LLT was reported so far. The present study aimed at the regression and palque contents via serial intravascular ultrasound(IVUS) after administration of fluvastatin and atorvastatin.Methods Seventy patients with at least one major coronary artery≥20-50% diameter stenosis by visual estimation according to coronary angiography between August 2007 and April 2008 were studied and randomly divided into two groups:atorvastatin (20mg/d, 35 patients) and fluvastatin (80mg/d,35 patients) groups.The inclusion and exclusion criteria were based on the baseline serum profiles and IVUS screening. IVUS at 12-month follow-up was indexed after continuous administration of statins. The change of the vessel,lumen and plaque volumes of coronary atherosclerosis plaque, and the change of plaque composition(defined as follow-up minus baseline) were generated by using dedicated off-line analysis software for the gray-scale intravascular ultrasound imaging (conventional IVUS gray -scale images, C-IVUS) and intravascular ultrasound virtual histology imaging (virtual histology intravascular ultrasound , VH-IVUS),respectively.Results Of a total of 70 patients, clinical and IVUS follow-up were available in 56 patients(80%,28 cases in each group),with 11 patients lost during 12-month follow-up, 1 intolerent to side effects of statins and 2 acute myocardial infarction. By the end of 12 months, low-density lipoprotein cholesterol (LDL-C) level in entire cohort of patients decreased from 3.39±0.67mmol/L at baseline to 2.43±0.74mmol/L at 12-month (P<0.001), with significant reduction in atorvastatin group (from 3.43±0.65mmol/L to 2.11±0.41mmol/L, with a reduction of -36.9±14.7% ),compared to fluvastatin group(from 3.36±0.69mmol/L to 2.75±0.85mmol/L, with a reduction of -16.1±30.3%,P=0.002). The natural logarithm (lnhs-CRP) of serum high-sensitivity C-reactive protein (hs-CRP) decreased significantly in both groups without significance between atorvastatin(from 0.48±0.74 at baseline to -0.29±1.10 at 12-month) and fluvastatin(from 0.26±0.92 to -0.24±0.76,P=0.77) groups. Plaque volume in atorvastatin group reduced from 351.0±152.2mm3 at baseline to 314.4±112.9mm3 at 12-month(a reduction of 8.5±12.9%), significantly different to fluvastatin group(from 294.6±87.6mm3 to 308.4±91.5mm3, a reduction of +4.7±9.2%, P<0.001).This led to the increase of lumen volume in atovastatin group, compared to fluvastatin group. In the atorvastatin group,the plaque volume reduction showed a significant positive correlation with LDL-C level decrease(r=0.586,P=0.001). Proportion of the necrosis core (NC) in the atorvastatin group decreased from 13.8±3.9% at baseline to 10.8±6.9% at 12-month(P=0.023) , without significant difference in fluvastatin group(from 12.7±3.4% to 15.0±7.8%, P = 0.111), dissimilar to the change of fibrous(FI) proportion(increased from 67.0±5.1% at baseline to 68.0±7.1% at 12-month in atorvastatin group ,P=0.378;decreased from 65.1±7.2% to 61.4±10.3% in fluvastatin group,P=0.015). The change of NC was not significantly correlated with the percent LDL-C reduction (r=0.263,P=0.177) and the decrease of plaque volume(r=0.157,P=0.426).Conclusions Lipid-lowering therapy by 20mg atorvastatin for 12 months significantly reduced coronary atherosclerosis plaque volume and the proportion of necrotic core. The percent of plaque volume decrease showed a significant positive correlation with percent LDL-C level reduction in the atorvastatin group. While 80mg fluvastatin could not prevent the progression of atherosclerosis. |
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