Li Z N, Hou Z H, Liu K, Wang Z Q, Yin W H, Gao Y, Xu H Y, Jiang S L, Lyu B
Department of Radiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Jun 24;44(6):508-12. doi: 10.3760/cma.j.issn.0253-3758.2016.06.010.
To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography.
A total of 120 consecutive patients (74 men, ages(58.9±8.1)years) with mild (≤50%luminal narrowing and lesion length<20 mm) non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study.Subjects were divided into three groups: no statin (n=36), statin lowering LDL-C <50% (n=43), and statin lowering LDL-C ≥50%(n=41). Serial scans were performed after a median interval of 705 (interquartile range: 467, 803) days.Total plaque volume, percent plaque volume for both baseline and follow-up were measured.Baseline and follow-up data were compared.
Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up ((97.3±57.8) mm(3) vs. (82.2±57.7) mm(3,) P=0.075). However, no significant change was observed as for total plaque volume ((78.5±45.2) mm(3) vs.(77.6±50.5) mm(3), P=0.910) in the statin lowering LDL-C <50% group.Total plaque volume was significantly reduced by the end of follow-up ((61.5 ± 46.1) mm(3) vs.(77.7±48.1) mm(3), P=0.024) in the statin lowering LDL-C ≥50% group.Percent plaque volume in no statin group was significantly increased by the end of follow-up ((51.9±16.5)% vs.(45.9±12.8)%, P=0.036). However, no significant change was observed as for percent plaque volume ((49.1±13.7)% vs.(47.5±14.9)%, P=0.554) in the statin lowering LDL-C <50% group. Percent plaque volume was significantly reduced by the end of follow-up ((39.1±17.1)% vs.(48.2±15.0)%, P=0.003) in the statin lowering LDL-C ≥50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume(β=-0.50, P<0.001) and statin lowering LDL-C ≥50%(β=-0.32, P=0.001) were independent determinants of plaque regression.
This study suggests that LDL-C reduction ≥50% post statin treatment can retard plaque progression, and even induce regression of mild non-calcified coronary plaque, patients with greater baseline coronary plaque volume are more likely to benefit from statin therapy.
通过连续冠状动脉CT血管造影评估他汀类药物治疗对轻度冠状动脉斑块进展的影响。
2012年9月至2013年12月期间，共有120例连续患者（74例男性，年龄(58.9±8.1)岁）因冠状动脉CT血管造影检测出轻度（管腔狭窄≤50%且病变长度<20 mm）非钙化斑块而被前瞻性纳入本研究。受试者分为三组：未服用他汀类药物组（n=36）、他汀类药物使低密度脂蛋白胆固醇（LDL-C）降低<50%组（n=43）和他汀类药物使LDL-C降低≥50%组（n=41）。在中位间隔705天（四分位间距：467, 803）后进行连续扫描。测量基线和随访时的总斑块体积、斑块体积百分比。比较基线和随访数据。
与基线相比，未服用他汀类药物组在随访结束时总斑块体积呈增加趋势（(97.3±57.8) mm³ 对 (82.2±57.7) mm³，P=0.075）。然而，他汀类药物使LDL-C降低<50%组的总斑块体积未观察到显著变化（(78.5±45.2) mm³ 对 (77.6±50.5) mm³，P=0.910）。他汀类药物使LDL-C降低≥50%组在随访结束时总斑块体积显著减少（(61.5 ± 46.1) mm³ 对 (77.7±48.1) mm³，P=0.024）。未服用他汀类药物组在随访结束时斑块体积百分比显著增加（(51.9±16.5)% 对 (45.9±12.8)%，P=0.036）。然而，他汀类药物使LDL-C降低<50%组的斑块体积百分比未观察到显著变化（(49.1±13.7)% 对 (47.5±14.9)%，P=0.554）。他汀类药物使LDL-C降低≥50%组在随访结束时斑块体积百分比显著减少（(39.1±17.1)% 对 (48.2±15.0)%，P=0.003）。多变量线性回归分析显示，较高的基线总斑块体积（β=-0.50，P<0.001）和他汀类药物使LDL-C降低≥50%（β=-0.32，P=0.001）均是斑块消退的独立决定因素。
本研究表明，他汀类药物治疗后LDL-C降低≥50%可延缓斑块进展，甚至促使轻度非钙化冠状动脉斑块消退，基线冠状动脉斑块体积较大的患者更可能从他汀类药物治疗中获益。
