Yonsei Med J.  2016 Sep;57(5):1087-1094. 10.3349/ymj.2016.57.5.1087.

Early Effects of Intensive Lipid-Lowering Treatment on Plaque Characteristics Assessed by Virtual Histology Intravascular Ultrasound

• Lee JH
• Shin DH
• Kim BK
• Ko YG
• Choi D
• Jang Y
• Hong MK

• KMID: 2374152
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1087

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.

Keyword

Coronary artery disease; coronary vessels; ultrasonography; cholesterol; anticholesteremic agents

MeSH Terms

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
Cholesterol, LDL
Ezetimibe, Simvastatin Drug Combination
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Pravastatin

Figure

• 

  Fig. 1 Changes in absolute volume of fibro-fatty plaque. (A) The absolute volume of fibro-fatty plaque changed from 6.0±3.8 mm3 at baseline to 6.7±5.8 mm3 at three-month follow-up after control statin treatment (pravastatin 20 mg). (B) The absolute volume of fibro-fatty plaque decreased from 5.2±4.0 mm3 at baseline to 3.7±2.6 mm3 at three-month follow-up after intensive lipid-lowering treatment (ezetimibe/simvastatin, 10/40 mg).

• 

  Fig. 2 Correlation between change in low-density lipoprotein (LDL)-cholesterol and change in absolute volume of each plaque component. (A) Fibro-fatty plaque, (B) fibrous plaque, (C) necrotic core, and (D) dense calcium. Blue circles denote control group, and red triangles are for intensive lipid-lowering group.

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