Intensification of statin therapy results in a rapid reduction in atherosclerotic inflammation: results of a multicenter fluorodeoxyglucose-positron emission tomography/computed tomography feasibility study.

Abstract

OBJECTIVES:

The study sought to test whether high-dose statin treatment would result in greater reductions in plaque inflammation than low-dose statins, using fluorodeoxyglucose-positron emission tomography/computed tomographic imaging (FDG-PET/CT).

BACKGROUND:

Intensification of statin therapy reduces major cardiovascular events.

METHODS:

Adults with risk factors or with established atherosclerosis, who were not taking high-dose statins (n = 83), were randomized to atorvastatin 10 versus 80 mg in a double-blind, multicenter trial. FDG-PET/CT imaging of the ascending thoracic aorta and carotid arteries was performed at baseline, 4, and 12 weeks after randomization and target-to-background ratio (TBR) of FDG uptake within the artery wall was assessed while blinded to time points and treatment.

RESULTS:

Sixty-seven subjects completed the study, providing imaging data for analysis. At 12 weeks, inflammation (TBR) in the index vessel was significantly reduced from baseline with atorvastatin 80 mg (% reduction [95% confidence interval]: 14.42% [8.7% to 19.8%]; p < 0.001), but not atorvastatin 10 mg (% reduction: 4.2% [-2.3% to 10.4%]; p > 0.1). Atorvastatin 80 mg resulted in significant additional relative reductions in TBR versus atorvastatin 10 mg (10.6% [2.2% to 18.3%]; p = 0.01) at week 12. Reductions from baseline in TBR were seen as early as 4 weeks after randomization with atorvastatin 10 mg (6.4% reduction, p < 0.05) and 80 mg (12.5% reduction, p < 0.001). Changes in TBR did not correlate with lipid profile changes.

CONCLUSIONS:

Statin therapy produced significant rapid dose-dependent reductions in FDG uptake that may represent changes in atherosclerotic plaque inflammation. FDG-PET imaging may be useful in detecting early treatment effects in patients at risk or with established atherosclerosis.

• Authors: Ahmed Tawakol, Zahi A Fayad, Robin Mogg, Achilles Alon, Michael T Klimas, Hayes Dansky, Sharath S Subramanian, Amr Abdelbaky, James H F Rudd, Michael E Farkouh, Irene O Nunes, Chan R Beals, Sudha S Shankar
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 62 Issue 10 Pg. 909-17 (Sep 03 2013) ISSN: 1558-3597 [Electronic] United States
• PMID: 23727083 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Heptanoic Acids
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Pyrroles
• Fluorodeoxyglucose F18
• Atorvastatin

Topics

• Adult
• Aged
• Aged, 80 and over
• Aorta, Thoracic (diagnostic imaging, pathology)
• Atherosclerosis (diagnostic imaging, drug therapy)
• Atorvastatin
• Carotid Arteries (diagnostic imaging, pathology)
• Double-Blind Method
• Feasibility Studies
• Female
• Fluorodeoxyglucose F18
• Heptanoic Acids (administration & dosage, therapeutic use)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (administration & dosage, therapeutic use)
• Inflammation (diagnostic imaging, drug therapy)
• Male
• Middle Aged
• Multimodal Imaging (methods)
• Plaque, Atherosclerotic (diagnostic imaging, drug therapy)
• Positron-Emission Tomography (methods)
• Pyrroles (administration & dosage, therapeutic use)
• Treatment Outcome