Søren Auscher1, Laurits Heinsen2, Koen Nieman3, Kristina Høeg Vinther2, Brian Løgstrup2, Jacob Eifer Møller4, Alexander Broersen5, Pieter Kitslaar5, Jess Lambrechtsen2, Kenneth Egstrup2. 1. Department of Medical Research, OUH/Svendborg Hospital, Denmark. Electronic address: sorenauscher@sol.dk. 2. Department of Medical Research, OUH/Svendborg Hospital, Denmark. 3. Department of Cardiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands. 4. Department of Cardiology, Odense University Hospital, Denmark. 5. Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
BACKGROUND: Statins have been shown to possess favourable effects on the cardiovascular system with stabilization of the vulnerable plaque. We sought to assess the effects of early aggressive statin treatment on plaque composition in patients with acute myocardial infarction (AMI), using serial assessment with coronary CT-angiography (CTA). METHODS: In a prospective randomized blinded endpoint trial patients with AMI were randomized to an intensive lipid lowering treatment receiving statin loading with 80 mg rosuvastatin followed by 40 mg daily or standard statin therapy according to current guidelines. Patients were assessed with CTA at baseline and after 12 months with evaluation of plaque volume and composition. RESULTS: In total, 140 patients with AMI were randomized and plaque composition was assessed in 96 patients. In the intensive care group LDL-level was median 1.3 [0.9; 1.5] mmol/l at 12 months follow-up and 2.0 [1.7; 2.4] mmol/l in the usual care group, p < 0.001. Plaque volume increased over 12 months with 43.5 (±225.8) mm(3) in the intensive care group and 19.1 (±190.2) mm(3) in the usual care group, p = 0.57. Plaque composition changed over 12 months with an increase in total dense calcium volume by 11.1 (±39.6) mm(3), corresponding to a 23% increase, in the intensive care group and a decreased by -0.4 (±26.6) mm(3) in the usual care group, p < 0.001. Necrotic core volume increased 26.8 (±122.1) mm(3) in the intensive care group and 25.2 (±80.1) mm(3) in the usual care group, p = 0.94. CONCLUSIONS: Early aggressive lipid lowering therapy significantly increases dense calcium volume in patients with AMI.
RCT Entities:
BACKGROUND: Statins have been shown to possess favourable effects on the cardiovascular system with stabilization of the vulnerable plaque. We sought to assess the effects of early aggressive statin treatment on plaque composition in patients with acute myocardial infarction (AMI), using serial assessment with coronary CT-angiography (CTA). METHODS: In a prospective randomized blinded endpoint trial patients with AMI were randomized to an intensive lipid lowering treatment receiving statin loading with 80 mg rosuvastatin followed by 40 mg daily or standard statin therapy according to current guidelines. Patients were assessed with CTA at baseline and after 12 months with evaluation of plaque volume and composition. RESULTS: In total, 140 patients with AMI were randomized and plaque composition was assessed in 96 patients. In the intensive care group LDL-level was median 1.3 [0.9; 1.5] mmol/l at 12 months follow-up and 2.0 [1.7; 2.4] mmol/l in the usual care group, p < 0.001. Plaque volume increased over 12 months with 43.5 (±225.8) mm(3) in the intensive care group and 19.1 (±190.2) mm(3) in the usual care group, p = 0.57. Plaque composition changed over 12 months with an increase in total dense calcium volume by 11.1 (±39.6) mm(3), corresponding to a 23% increase, in the intensive care group and a decreased by -0.4 (±26.6) mm(3) in the usual care group, p < 0.001. Necrotic core volume increased 26.8 (±122.1) mm(3) in the intensive care group and 25.2 (±80.1) mm(3) in the usual care group, p = 0.94. CONCLUSIONS: Early aggressive lipid lowering therapy significantly increases dense calcium volume in patients with AMI.
Authors: Stefan B Puchner; Thomas Mayrhofer; Jakob Park; Michael T Lu; Ting Liu; Pal Maurovich-Horvat; Khristine Ghemigian; Daniel O Bittner; Jerome L Fleg; James E Udelson; Quynh A Truong; Udo Hoffmann; Maros Ferencik Journal: Atherosclerosis Date: 2018-04-17 Impact factor: 5.162
Authors: Veit Sandfort; David A Bluemke; Jose Vargas; Jeffrey A Brinker; Gary Gerstenblith; Thomas Kickler; Gang Zheng; Ji Li; Shaoguang Chen; Hong Lai; Elliot K Fishman; Shenghan Lai Journal: J Addict Med Date: 2017 Mar/Apr Impact factor: 3.702
Authors: Lynne E Wagenknecht; Jasmin Divers; Thomas C Register; Gregory B Russell; Donald W Bowden; Jianzhao Xu; Carl D Langefeld; Leon Lenchik; Keith A Hruska; J Jeffrey Carr; Barry I Freedman Journal: J Clin Endocrinol Metab Date: 2016-08-23 Impact factor: 5.958
Authors: Parker Foster; Lori Sokoll; Ji Li; Gary Gerstenblith; Elliot K Fishman; Thomas Kickler; Shaoguang Chen; Hong Tai; Hong Lai; Shenghan Lai Journal: Int J STD AIDS Date: 2018-10-31 Impact factor: 1.359