Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study.

Abstract

BACKGROUND:

Recent clinical trials have demonstrated that aggressive lipid lowering by statins could prevent recurrent events after acute coronary syndrome (ACS). We hypothesized that this efficacy was caused by a significant reduction in plaque volume by aggressive LDL cholesterol (LCL-C) lowering. The present study investigated the effect of early statin treatment on plaque volume of a nonculprit lesion by serial volumetric intravascular ultrasound in patients with ACS.

METHODS AND RESULTS:

Seventy patients with ACS were enrolled. All patients underwent emergency coronary angiography and percutaneous coronary intervention (PCI). They were randomized to intensive lipid-lowering therapy (n=35; atorvastatin 20 mg/d) or control (n=35) groups after PCI. Volumetric intravascular ultrasound analyses were performed at baseline and 6-month follow-up for a non-PCI site in 48 patients (atorvastatin, n=24; control, n=24). LDL-C level was significantly decreased by 41.7% in the atorvastatin group compared with the control group, in which LDL-C was increased by 0.7% (P<0.0001). Plaque volume was significantly reduced in the atorvastatin group (13.1+/-12.8% decrease) compared with the control group (8.7+/-14.9% increase; P<0.0001). Percent change in plaque volume showed a significant positive correlation with follow-up LDL-C level (R=0.456, P=0.0011) and percent LDL-C reduction (R=0.612, P<0.0001), even in patients with baseline LDL-C <125 mg/dL.

CONCLUSIONS:

Early aggressive lipid-lowering therapy by atorvastatin for 6 months significantly reduced the plaque volume in patients with ACS. Percent change in plaque volume showed a significant positive correlation with percent LDL-C reduction, even in patients with low baseline LDL-C.

• Authors: Shinya Okazaki, Takayuki Yokoyama, Katsumi Miyauchi, Kazunori Shimada, Takeshi Kurata, Hitoshi Sato, Hiroyuki Daida
• Journal: Circulation (Circulation) Vol. 110 Issue 9 Pg. 1061-8 (Aug 31 2004) ISSN: 1524-4539 [Electronic] United States
• PMID: 15326073 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)

Chemical References

• Anticoagulants
• Cardiovascular Agents
• Cholesterol, LDL
• Heptanoic Acids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Platelet Aggregation Inhibitors
• Pyrroles
• Tetrazoles
• Heparin
• Atorvastatin
• Cilostazol
• Ticlopidine
• Aspirin

Topics

• Acute Disease
• Aged
• Angioplasty, Balloon, Coronary
• Anticoagulants (therapeutic use)
• Aspirin (therapeutic use)
• Atorvastatin
• Cardiovascular Agents (therapeutic use)
• Cholesterol, LDL (blood)
• Cilostazol
• Combined Modality Therapy
• Coronary Angiography
• Coronary Disease (blood, diagnostic imaging, drug therapy, therapy)
• Female
• Follow-Up Studies
• Heparin (therapeutic use)
• Heptanoic Acids (administration & dosage, therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage, therapeutic use)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (therapeutic use)
• Prospective Studies
• Pyrroles (administration & dosage, therapeutic use)
• Tetrazoles (therapeutic use)
• Ticlopidine (therapeutic use)
• Treatment Outcome
• Ultrasonography, Interventional