Effect of intensive atorvastatin therapy on coronary atherosclerosis progression, composition, arterial remodeling, and microvascular function

• Published in: The Journal of invasive cardiology 2012-10, Vol.24 (10), p.522-529
• Main Authors: Eshtehardi, Parham, McDaniel, Michael C, Dhawan, Saurabh S, Binongo, José Nilo G, Krishnan, Sandeep K, Golub, Lucas, Corban, Michel T, Raggi, Paolo, Quyyumi, Arshed A, Samady, Habib
• Format: Article
• Language: English
• Subjects: Aged; Anticholesteremic Agents - pharmacology; Anticholesteremic Agents - therapeutic use; Atorvastatin Calcium; Cholesterol - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - drug therapy; Coronary Artery Disease - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - drug effects; Coronary Vessels - physiopathology; Disease Progression; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Heptanoic Acids - pharmacology; Heptanoic Acids - therapeutic use; Humans; Male; Microvessels - diagnostic imaging; Microvessels - drug effects; Microvessels - physiopathology; Middle Aged; Phenotype; Pilot Projects; Pyrroles - pharmacology; Pyrroles - therapeutic use; Regional Blood Flow - drug effects; Regional Blood Flow - physiology; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional; Vascular Resistance - drug effects; Vascular Resistance - physiology
• ISSN: 1557-2501

There is a discrepancy between the marked reduction in adverse events with statins and their modest effect on atheroma regression. We hypothesized that, in a Western population, high-dose atorvastatin will result in alterations in coronary atheroma composition, phenotype, and microvascular function. Serial coronary radiofrequency intravascular ultrasound (VH-IVUS), coronary flow reserve (CFR), and hyperemic microvascular resistance (HMR) were performed at baseline and after 6 months of treatment with 80 mg atorvastatin in 20 patients with moderate coronary artery disease (CAD). For each VH-IVUS frame (n = 2249), changes in total plaque atheroma, composition, and phenotype (pathological intimal thickening, fibrotic plaque, fibroatheroma), and serial remodeling were assessed. Total serum cholesterol decreased from 186.0 mg/dL (interquartile range [IQR], 168.0 to 212.5 mg/dL) to 139.0 mg/dL (IQR, 124.3 to 151.3 mg/dL). Percent atheroma volume did not change significantly (-0.5% [IQR, -2.8% to 3.7%]; P=.90) and serial remodeling analysis demonstrated 40% constrictive, 24% incomplete, and 36% expansive patterns. There was a trend toward lower percent fibrous tissue (-3.47 ± 1.78%; P=.07) and percent fibro-fatty tissue (-2.52 ± 1.24%; P=.06) and increase in percent necrotic core (+2.74 ± 1.65%; P=.11) and percent dense calcium (+1.99 ± 0.81; P=.02), which translated into significantly less pathological intimal thickening (4% vs 12%; P