SS11. Aggressive Lipid-Lowering is More Effective Than Moderate Lipid-Lowering Treatment in Carotid Plaque Stabilization
Article Outline
Objective
Atherosclerotic plaque stabilization is a promising strategy to prevent cerebrovascular events in patients with moderate carotid stenosis. This prospective study examined whether intensive lipid-lowering therapy is more effective in increasing carotid plaque echogenicity, assessed by Gray-Scale Median (GSM) score, and suppressing serum levels of osteopontin (OPN) and osteoprotegerin (OPG) in patients with carotid stenosis.
Methods
120 patients (51M/69F), aged 55-75, with carotid stenosis (NASCET: 40-60% for symptomatic and 40-70% for asymptomatic patients), thus without indications for surgical intervention, were included. Patients with previous use of statins were excluded. Patients were randomized to either intensive lipid-lowering therapy (Group A; n=60: target LDL-C<70mg/dl) or moderate lipid-lowering therapy (Group B; n=60: target LDL-C<100mg/dl). The ratio symptomatic/asymptomatic patients was equivalent in groups. All patients were treated with atorvastatin (10-80mg gradual titration) to reach the target. Biochemical parameters and GSM score were assessed at baseline and after 12 months. Independent samples t-test and Pearson correlation were used for statistical analysis (p<0.05).
Results
There were no significant differences between groups at baseline. Group A showed a more pronounced improvement in lipid profile compared with group B (p<0.05). Moreover atorvastatin treatment significantly suppressed of hsCRP, OPN and OPG serum levels across LDL levels downregulation (p<0.05).). Remarkable increment of carotid plaque echogenicity was noted in both groups, but that was considerably higher in group A than group B (table 1).Notably GSM score augmentation was inversely associated with OPN (p=0.031) and OPG (p=0.002) changes in the whole study group.
Table 1. Changes of lipid parameters, osteopontin, osteoprotegerin, hsCRP and GSM in both groups
| Group A | Group B | p | |||
|---|---|---|---|---|---|
| Baseline | Change | Baseline | Change | ||
| T.Cholesterol (mg/dl) | 200.6±44.1 | −68.5±17.2⁎ | 209±50.6 | −45.1±14.3⁎ | 0.048 |
| HDL-C (mg/dl) | 36.6±10 | 4.6±1.1⁎ | 34.2±13.6 | 1.3±0.5 | 0.017 |
| LDL-C (mg/dl) | 153.8±36.5 | −74±22.9⁎ | 146.1±43.3 | −44.9±10.8⁎ | 0.018 |
| Triglycerides (mg/dl) | 151.3±50.2 | −37±14.4⁎ | 168.7±72.4 | −36.7±9.2⁎ | 0.984 |
| Osteopontin (ng/ml) | 74.63±28.64 | −45.9±24.6⁎ | 71.89±31.58 | −22.4±11.5⁎ | 0.002 |
| Osteoprotegerin (pmol/L) | 7.04±1.58 | −3.8±2.3⁎ | 7.56±2.37 | −2.84±1.3⁎ | 0.038 |
| hsCRP (mg/L) | 5.37±2.35 | −2.88±1.1⁎ | 5.5±3 | −2.1±0.55⁎ | 0.067 |
| GSM | 63.7±17.6 | 28.03±5.92⁎ | 63.1±12.6 | 20.81±4.33⁎ | 0.030 |
⁎p<0.05 values of changes of variables within groups. |
Conclusions
Intensive lipid-lowering therapy rather than moderate lipid-lowering therapy is more effective in increasing echogenicity of carotid plaques. This effect seems to be mediated by OPN and OPG suppression.
Author Disclosures: N.P.E. Kadoglou, Project “Pythagoras II”; Common Research Project “Hellas-Slovenia”; Grant by the Onassis Public Benefit Foundation; N. Sailer, None; A. Moumtzouoglou, None; A. Kapelouzou, None; G. Fotiadis, None; I. Vitta, None; I. Kakisis, None; E. Avgerinos, None; T. Gerasimidis, None; P. Karayannacos, None; C.D. Liapis, None.
PII: S0741-5214(09)00400-5
doi:10.1016/j.jvs.2009.02.142
© 2009 The Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.
