Daida Hiroyuki, Nohara Ryuji, Hata Mitsumasa, Kaku Kohei, Kawamori Ryuzo, Kishimoto Junji, Kurabayashi Masahiko, Masuda Izuru, Sakuma Ichiro, Yamazaki Tsutomu, Yokoi Hiroyoshi, Yoshida Masayuki
Department of Cardiology, Juntendo University, Graduate School of Medicine.
J Atheroscler Thromb. 2014;21(7):739-54. doi: 10.5551/jat.19109. Epub 2014 Jun 20.
This subanalysis aimed to clarify whether intensive lipid-lowering therapy with statins slows the progression of atherosclerosis in Japanese subjects under treatment for primary prevention of cardiovascular disease.
This was a subanalysis of the Justification for Atherosclerosis Regression Treatment (JART) Study. We compared the efficacy of intensive lipid-lowering therapy and conventional therapy with respect to changes in the mean intima-media thickness (IMT) and serum lipid levels. We also evaluated changes in the mean IMT over 24 months of treatment and assessed the relationship between these changes and reductions in the LDL-C levels using a post-hoc analysis.
Intensive lipid-lowering therapy with rosuvastatin was associated with significantly smaller changes in the mean IMT and a greater reduction in the serum lipid levels in comparison to conventional therapy with pravastatin. The average net change in the mean IMT was 0.010 mm (n=121) at 12 months and -0.004 mm (n=56) at 24 months. A decrease in LDL-C was found to be associated with a smaller change in the mean IMT (p=0.0009; Jonckheere-Terpstra trend test). A greater reduction in serum LDL-C was found to be associated with a smaller change in the mean IMT. Similar associations were observed for the serum TC and non-HDL-C levels and LDL-C/HDL-C ratio. There were no notable differences in the incidence of serious adverse events among the LDL-C quartiles.
Lowering the LDL-C level with intensive lipid-lowering therapy is associated with reduced changes in the IMT among Japanese subjects at moderate to high risk under treatment for primary prevention. Subjects suitable for primary prevention may receive cardiovascular benefits from intensive lipid-lowering therapy, in association with significantly slower IMT progression than that observed with conventional therapy.
本亚组分析旨在阐明，在接受心血管疾病一级预防治疗的日本受试者中，使用他汀类药物进行强化降脂治疗是否能减缓动脉粥样硬化的进展。
这是动脉粥样硬化消退治疗的理由（JART）研究的一项亚组分析。我们比较了强化降脂治疗与常规治疗在平均内膜中层厚度（IMT）和血脂水平变化方面的疗效。我们还评估了治疗24个月期间平均IMT的变化，并通过事后分析评估了这些变化与低密度脂蛋白胆固醇（LDL-C）水平降低之间的关系。
与使用普伐他汀的常规治疗相比，使用瑞舒伐他汀进行强化降脂治疗与平均IMT的变化显著更小以及血脂水平的更大降低相关。平均IMT的平均净变化在12个月时为0.010毫米（n = 121），在24个月时为-0.004毫米（n = 56）。发现LDL-C的降低与平均IMT的较小变化相关（p = 0.0009；琼克尔-特普斯特拉趋势检验）。发现血清LDL-C的更大降低与平均IMT的较小变化相关。对于血清总胆固醇（TC）、非高密度脂蛋白胆固醇（non-HDL-C）水平以及LDL-C/高密度脂蛋白胆固醇（HDL-C）比值，也观察到了类似的关联。在LDL-C四分位数之间，严重不良事件的发生率没有显著差异。
在接受一级预防治疗的中高风险日本受试者中，强化降脂治疗降低LDL-C水平与IMT的变化减少相关。适合一级预防的受试者可能从强化降脂治疗中获得心血管益处，与常规治疗相比，IMT进展明显更慢。
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