Corti Roberto, Fuster Valentin, Fayad Zahi A, Worthley Stephen G, Helft Gerard, Smith Donald, Weinberger Jesse, Wentzel Jolanda, Mizsei Gabor, Mercuri Michele, Badimon Juan J
Cardiovascular Biology Research Laboratory, Mount Sinai School of Medicine, New York, NY 10029, USA.
Circulation. 2002 Dec 3;106(23):2884-7. doi: 10.1161/01.cir.0000041255.88750.f0.
Statins are widely used to treat hypercholesterolemia and atherosclerotic disease. Noninvasive MRI allows serial monitoring of atherosclerotic plaque size changes. Our aim was to investigate the effects of lipid lowering with simvastatin on atherosclerotic lesions.
A total of 44 aortic and 32 carotid artery plaques were detected in 21 asymptomatic hypercholesterolemic patients at baseline. The effects of statin on these atherosclerotic lesions were evaluated as changes versus baseline in lumen area (LA), vessel wall thickness (VWT), and vessel wall area (VWA) by MRI. Maximal reduction of plasma total and LDL cholesterol by simvastatin (23% and 38% respectively; P<0.01 versus baseline) was achieved after approximately 6 weeks of therapy and maintained thereafter throughout the study. Significant (P<0.01) reductions in maximal VWT and VWA at 12 months (10% and 11% for aortic and 8% and 11% for carotid plaques, respectively), without changes in LA, have been reported. Further decreases in VWT and VWA ranging from 12% to 20% were observed at 18 and 24 months. A slight but significant increase (ranging from 4% to 6%) in LA was seen in both carotid and aortic lesions at these later time points.
The present study demonstrates that maintained lipid-lowering therapy with simvastatin is associated with significant regression of established atherosclerotic lesions in humans. Our observations indicate that lipid-lowering therapy is associated with sustained vascular remodeling and emphasize the need for longer-term treatment.
他汀类药物被广泛用于治疗高胆固醇血症和动脉粥样硬化疾病。无创性磁共振成像（MRI）可对动脉粥样硬化斑块大小变化进行连续监测。我们的目的是研究辛伐他汀降脂对动脉粥样硬化病变的影响。
在21例无症状高胆固醇血症患者基线时，共检测到44个主动脉斑块和32个颈动脉斑块。通过MRI评估他汀类药物对这些动脉粥样硬化病变的影响，以管腔面积（LA）、血管壁厚度（VWT）和血管壁面积（VWA）相对于基线的变化来衡量。辛伐他汀治疗约6周后，血浆总胆固醇和低密度脂蛋白胆固醇达到最大降幅（分别为23%和38%；与基线相比P<0.01），并在随后的整个研究中维持这一水平。据报道，12个月时最大VWT和VWA显著降低（P<0.01）（主动脉斑块分别降低10%和11%，颈动脉斑块分别降低8%和11%），而LA无变化。在18个月和24个月时，观察到VWT和VWA进一步下降，降幅在12%至20%之间。在这些较晚时间点，颈动脉和主动脉病变的LA均出现轻微但显著的增加（增幅在4%至6%之间）。
本研究表明，辛伐他汀持续降脂治疗与人类已形成的动脉粥样硬化病变显著消退相关。我们的观察结果表明，降脂治疗与持续的血管重塑有关，并强调了长期治疗的必要性。
