Abstract 13849: Impact of Statin-Ezetimibe Combination on Coronary Atheroma Progression/Regression in Patients With and Without Prior Statin Therapy - Subanalysis of PRECISE-IVUS Trial

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kenichi Tsujita ◽  
Kenshi Yamanaga ◽  
Seigo Sugiyama ◽  
Hideki Shimomura ◽  
Takuro Yamashita ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Cholesterol Absorption ◽  
Coronary Plaque ◽  
Regression Effect ◽  
Atheroma Volume ◽  
Plaque Regression ◽  
Coronary Atheroma

Introduction: IMPROVE-IT trial showed the clinical benefit of statin-ezetimibe (EZE) combination appeared to be pronounced in patients with prior statin therapy. On the other hand, the PRECISE-IVUS ( P laque RE gression with C holesterol absorption I nhibitor or S ynthesis inhibitor E valuated by I ntra V ascular U ltra S ound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile. Hypothesis: We hypothesized that the antiatherosclerotic effect of atorva-EZE combination was pronounced in patients with statin pretreatment. Methods: 246 patients undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination or atorva alone. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients. We compared the IVUS endpoints in all subjects, stratified by the presence of statin pretreatment. Results: The baseline LDL-C level (100.7±23.1mg/dL vs. 116.4±25.9mg/dL, p<0.001) and lathosterol (55 [38 to 87])μg/100mg TC vs. 97 [57 to 149]μg/100mg TC, p<0.001) was significantly lower, and campesterol/lathosterol ratio (3.9 [2.4 to 7.4] vs. 2.6 [1.5 to 4.1], p<0.001) was significantly accelerated in patients with statin pretreatment. Contrary to the patients without statin pretreatment (-1.3 [-3.1 to -0.1]% vs. -0.9 [-2.3 to 0.9]%, p=0.12), the atorva-EZE combination showed the significantly stronger reduction in delta percent atheroma volume, compared with atorva alone, in patients with statin pretreatment (-1.8 [-3.6 to -0.3]% vs. -0.1 [-1.6 to 0.8]%, p=0.002). Conclusions: Compared to atorva alone, atorva-EZE combination demonstrated stronger regression effect in coronary atheroma volume especially in patients with statin pretreatment. Compensatory accelerated cholesterol absorption might be associated with reduced coronary plaque regression. Low-dose statin-EZE combination might be a promising option in statin-hyporesponder.

Abstract 16913: Greater Coronary Atheroma Regression in Women Compared With Men: A Pooled Analysis of Serial Intravascular Ultrasonography Trials Utilizing High-intensity Statin Therapy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brian Stegman ◽  
Mingyuan Shao ◽  
Stephen Nichols ◽  
Mohamed Elshazly ◽  
Samir Kapadia ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Multivariable Analysis ◽  
Coronary Plaque ◽  
Pooled Analysis ◽  
Lower Baseline ◽  
Atheroma Volume ◽  
Plaque Regression ◽  
Post Hoc ◽  
Coronary Atheroma

Introduction: High-intensity statin therapy (HIST) reduces cardiovascular events, however sex-related differences in treatment effects are not well characterized, possibly contributing to gender disparities in HIST use. Hypothesis: Sex-related differences in coronary atheroma regression exist following HIST. Methods: We undertook a patient-level post-hoc pooled analysis of 3 randomized trials utilizing serial coronary IVUS to test the anti-atherosclerotic effects of HIST in patients with coronary disease. Sex-related differences in changes (Δ) in coronary percent atheroma volume (PAV) were ascertained following 18-24 months of either atorvastatin 80 mg or rosuvastatin 40 mg. Results: In women (n=451) compared with men (n=1190), levels of on-treatment LDL-C (68±24 vs. 68±22mg/dl, p=0.62) were similar, however HDL-C (53±12 vs. 47±11 mg/dl, p<0.01) and CRP [1.7 (0.9, 3.8) vs. 1.1 (0.6, 2.7) mg/l, p<0.01] were higher. Compared with men, women harbored lower baseline PAV (34.8±8.7 vs. 38.3±8.8%, p<0.001), yet demonstrated greater PAV regression (ΔPAV -1.07±0.26 vs. -0.66±0.23%, p=0.02). When achieved on-treatment LDL-C levels were <70mg/dl, women demonstrated greater PAV regression than men (-1.49±0.21 vs. -0.97±0.13%, p=0.035), however had similar rates of PAV regression with on-treatment LDL-C levels ≥70 mg/dl (-0.63±0.25 vs. -0.42±0.16%, p=0.47). Sex-related differences in atheroma regression did not differ according to achieved levels of HDL-C, non-HDL-C or CRP (Figure). Multivariable analysis revealed female sex to independently associate with PAV regression (coefficient -0.66, p=0.017). Conclusion: Women systematically demonstrate greater degrees of coronary plaque regression compared with men following long-term HIST, especially in the setting of lower achieved LDL-C levels. Further research is required for elucidating mechanisms underpinning sex-related variations in plaque progression-regression.

scholarly journals Association of Serum Lipoprotein (a) Levels and Coronary Atheroma Volume by Intravascular Ultrasound

2020 ◽  
Vol 9 (23) ◽  
Author(s):  
Chetan P. Huded ◽  
Nishant P. Shah ◽  
Rishi Puri ◽  
Stephen J. Nicholls ◽  
Kathy Wolski ◽  
...  
Keyword(s):  
Intravascular Ultrasound ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Plaque Burden ◽  
Low Density ◽  
Baseline Serum ◽  
Lipoprotein A ◽  
Atheroma Volume ◽  
The Relationship ◽  
Coronary Atheroma

Background Lp(a) (lipoprotein (a)) is a risk factor for cardiovascular events, but the mechanism of increased risk is uncertain. This study evaluated the relationship between Lp(a) and coronary atheroma volume by intravascular ultrasound. Methods and Results This was a post hoc analysis of 6 randomized trials of coronary atheroma by intravascular ultrasound. The population was stratified into high (≥60 mg/dL) and low (<60 mg/dL) baseline serum Lp(a). The primary outcome was baseline coronary percent atheroma volume. A mixed model adjusted for baseline low density lipoprotein, ApoB (apoliporotein B100), non‐high density lipoprotein, sex, age, race, history of myocardial infarction, statin use, and intravascular ultrasound study was used to provide estimates of baseline plaque burden. Of 3943 patients, 17.3% (683) had Lp(a) ≥ 60 mg/dL and 82.7% (3260) had Lp(a) < 60 mg/dL. At baseline, uncorrected low density lipoprotein level (107.7 ± 32.0 versus 99.1 ± 31.5) and statin therapy (99.0% versus 97.0%) were higher in patients with high Lp(a) levels, but low density lipoprotein corrected for Lp(a) was lower (80.6 ± 32.0 versus 94.0 ± 31.4) in patients with high Lp(a) levels. Percent atheroma volume was significantly higher in the high Lp(a) group in unadjusted (38.2% [32.8, 43.6] versus 37.1% [31.4, 43.1], P =0.01) and risk‐adjusted analyses (38.7%±0.5 versus 37.5%±0.5, P <0.001). There was a significant association of increasing risk‐adjusted percent atheroma volume across quintiles of Lp(a) (Lp(a) quintiles 1‐5; 37.3 ± 0.5%, 37.2 ± 0.5%, 37.3 ± 0.5%, 38.0 ± 0.5%, 38.5 ± 0.5%, P =0.002). Conclusions Elevated Lp(a) is independently associated with increased percent atheroma volume. Further work is needed to clarify the relationship of Lp(a)‐lowering treatment with cardiovascular outcomes.

scholarly journals Ezetimibe and Improving Cardiovascular Outcomes: Current Evidence and Perspectives

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Akshyaya Pradhan ◽  
Monika Bhandari ◽  
Rishi Sethi
Keyword(s):  
Statin Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cholesterol Absorption ◽  
Cardiovascular Outcomes ◽  
Current Evidence ◽  
High Dose ◽  
Residual Cardiovascular Risk ◽  
Intestinal Cholesterol Absorption ◽  
Cholesterol Absorption Inhibitor

Low-density lipoprotein lowering with statins has convincingly and consistently proven to reduce cardiovascular events in both primary and secondary prevention. However, despite high-dose statin therapy, residual cardiovascular risk remains and many patients also do not tolerate statins. Ezetimibe was initially projected as a frontline alternative to statin. It is an intestinal cholesterol absorption inhibitor with modest LDL lowering effects. But, major studies failed to demonstrate any beneficial effect of CV outcomes, and the drug was relegated to oblivion. IMPROVE-IT, a contemporary, large, and well-designed trial, unequivocally demonstrated reduction in CV outcomes with ezetimibe when added to statin therapy. The benefits are seen in both sexes, elderly, CKD, diabetes mellitus, and in patients with prior CABG. It also reduces biomarkers and induces plaque regression like statins. The drug has now established itself as an add-on therapy to statin when monotherapy fails to achieve LDL goals and when it is not tolerated. The combination therapy has excellent safety and efficacy record. It has now been endorsed by major guidelines too in management of dyslipidemia. Yes, ezetimibe can indeed improve cardiovascular outcomes!

scholarly journals Effects of statin therapy on coronary plaque volume by decreasing CRP/hsCRP levels: A meta-regression of randomized controlled trials

2021 ◽  
Author(s):  
Darui Gao ◽  
Rong Hua ◽  
Dina Jiesisibieke ◽  
Yanjun Ma ◽  
Chenglong Li ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Meta Analysis ◽  
Coronary Plaque ◽  
Plaque Volume ◽  
Percent Change ◽  
Randomized Controlled ◽  
Atheroma Volume ◽  
Plaque Regression ◽  
Meta Regression ◽  
Meta Regression Analysis

Background and aims: Several clinical trials have indicated that statins stabilize and reverse atherosclerotic plaque. However, different studies have provided inconsistent findings regarding mechanisms and influencing factors of plaque regression under statin therapy. In this study, meta-analysis and meta-regression were used to determine the effect of statin medication on coronary plaque volume as determined by intravenous ultrasound. Meanwhile, the impact of statins on CRP/hsCRP reduction on plaque regression was discussed. Methods: Up to May 28, 2021, a systematic PubMed, EMBASE, and Cochrane search was performed for randomized controlled trials that assessed treatment effect using total atheroma volume (TAV), percent atheroma volume (PAV), or plaque volume (PV). Only CRP/hsCRP and LDL-C values reported before and after treatment were considered. Results: 12 studies fulfilled the inclusion criteria and were included in the systematic review. Compared with control groups, meta-analysis of 15 statin-treated arms reported change of TAV/PV showed standardized mean difference (SMD) at -0.27 (95% confidence intervals [CI]: -0.42, -0.12). Meta-analysis of 7 studies reported change of PAV revealed SMD at -0.16 (95% CI: -0.29, -0.03). Meta-regression analysis revealed percent change of CRP/hsCRP statistically influences SMD in change of TAV/PVafter adjusting for percent change of LDL-C, age and gender. Meta-regression analysis showed that percent change of CRP/hsCRP statistically influences SMD in change of PAV. Conclusion: In conclusion, statin therapy is beneficial for plaque regression. Statins promote plaque regression through their anti-inflammatory ability while lowering LDL-C is unaffected. Keywords: Statins; Reduction of atherosclerosis; C-reactive protein; Randomized controlled trial; Meta-analysis

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