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
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.
1Aristotle's University of Thessaloniki, Thessaloniki, Greece
2Foundation of Biomedical Research, Academy of Athens, Athens, Greece
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.
FULL TEXT
