Heart Health, South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2014 Aug 15;114(4):549-54. doi: 10.1016/j.amjcard.2014.05.035. Epub 2014 Jun 6.
Potent statin therapy has been demonstrated to reduce cardiovascular events. Although statins have been considered to stabilize atherosclerotic plaque, this effect has not been well characterized in vivo. We investigated the relation between potent statin therapy and plaque microstructures imaged by frequency-domain optical coherence tomography. Two hundred ninety nonculprit lipid plaques in 275 patients with stable coronary artery disease receiving atorvastatin or rosuvastatin were analyzed. Patients were stratified into no statin, low-, and high-dose statin groups. Plaques in the high-dose statin group demonstrated a smaller lipid arc (p = 0.02) and a greater fibrous cap thickness (p = 0.01). In patients receiving statin therapy, high-dose statin therapy was associated with a greater fibrous cap thickness in patients with smaller (148.2 ± 30.5 vs 105.3 ± 41.1 μm, p = 0.004) but not larger lipid index (91.1 ± 32.6 vs 78.1 ± 43.3 μm, p = 0.21). In conclusion, potent statin therapy is associated with less vulnerable plaque features on frequency-domain optical coherence tomography imaging. This finding varies according to the size of plaque lipid content, being less effective in lipid-loaded plaques.
强效他汀类药物治疗已被证明可降低心血管事件的发生。尽管他汀类药物被认为可以稳定动脉粥样硬化斑块，但这种作用在体内尚未得到很好的描述。我们通过频域光相干断层扫描（FD-OCT）研究了强效他汀类药物治疗与斑块微观结构之间的关系。分析了 275 例接受阿托伐他汀或瑞舒伐他汀治疗的稳定型冠心病患者的 290 个非罪犯脂质斑块。将患者分为无他汀组、低剂量他汀组和高剂量他汀组。高剂量他汀组的斑块脂质弧形更小（p=0.02），纤维帽更厚（p=0.01）。在接受他汀类药物治疗的患者中，高剂量他汀类药物治疗与较小脂质指数（148.2±30.5 比 105.3±41.1μm，p=0.004）但不是较大脂质指数（91.1±32.6 比 78.1±43.3μm，p=0.21）患者的纤维帽更厚相关。总之，强效他汀类药物治疗与 FD-OCT 成像上更不易发生的斑块特征有关。这一发现根据斑块脂质含量的大小而有所不同，在载脂蛋白 B 含量高的斑块中效果较差。
