Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Interventional Cardiology, Tokyo Medical & Dental University, Tokyo, Japan.
Am J Cardiol. 2019 May 15;123(10):1565-1571. doi: 10.1016/j.amjcard.2019.02.019. Epub 2019 Feb 23.
Statins are widely used to lower cholesterol and to reduce cardiovascular events. Whether all statins have similar effects on plaque stabilization is unknown. We aimed to investigate coronary plaque response to treatment with different statins that result in similar lipid reduction using serial multimodality intracoronary imaging. Patients with de novo coronary artery disease requiring intervention were randomized to rosuvastatin 10mg (R10) or atorvastatin 20mg (A20) daily. Optical coherence tomography and intravascular ultrasound were performed at baseline, 6 months, and 12 months. Untreated nonculprit plaques were analyzed by optical coherence tomography for thin-cap fibroatheroma, minimum fibrous cap thickness, lipid arc, and lipid length. Total and percent atheroma volume, respectively were analyzed by intravascular ultrasound. Forty-three patients completed the protocol (R10: 24 patients, 31 plaques; A20: 19 patients, 30 plaques). The decrease in serum lipids was similar. From baseline to 6 months to 12 months, minimum fibrous cap thickness increased in the R10 group (61.4 ± 15.9 µm to 120.9 ± 57.9 µm to 171.5 ± 67.8 µm, p <0.001) and the A20 group (60.8 ± 18.1 µm to 99.2 ± 47.7 µm to 127.0± 66.8 µm, p <0.001). Prevalence of thin-cap fibroatheroma significantly decreased in the R10 and A20 groups (-48% and -53%, respectively, p <0.001 for intragroup comparisons). Only the R10 group had a decrease in macrophage density (-23%, p = 0.04) and microvessels (-12%, p = 0.002). Total atheroma volume decreased in the R10 group (109.2 ± 62.1 mm to 101.8 ± 61.1 mm to 102.5 ± 62.2 mm, p = 0.047) but not in the A20 group (83.3 ± 48.5mm to 77.6 ± 43.0 mm to 77.9 ± 48.6 mm, p = 0.07). In conclusion, although both statins demonstrated similar reductions in lipid profiles, the rosuvastatin group showed more rapid and robust plaque stabilization, and regression of plaque volume compared to the atorvastatin group.
他汀类药物广泛用于降低胆固醇和减少心血管事件。然而，尚不清楚所有他汀类药物在稳定斑块方面是否具有相似的效果。我们旨在使用连续多模态冠状动脉内成像研究不同他汀类药物治疗导致相似降脂效果的冠状动脉斑块反应。需要介入治疗的新发冠状动脉疾病患者被随机分配至瑞舒伐他汀 10mg（R10）或阿托伐他汀 20mg（A20）每日一次。在基线、6 个月和 12 个月时进行光学相干断层扫描和血管内超声检查。通过光学相干断层扫描分析未经治疗的非罪犯斑块的薄帽纤维粥样瘤、最小纤维帽厚度、脂质弧和脂质长度。通过血管内超声分析总动脉粥样硬化体积和百分比。43 例患者完成了方案（R10：24 例，31 个斑块；A20：19 例，30 个斑块）。血清脂质的降低相似。从基线到 6 个月再到 12 个月，R10 组最小纤维帽厚度增加（61.4±15.9μm 至 120.9±57.9μm 至 171.5±67.8μm，p<0.001）和 A20 组（60.8±18.1μm 至 99.2±47.7μm 至 127.0±66.8μm，p<0.001）。薄帽纤维粥样瘤的患病率在 R10 和 A20 组均显著降低（分别为-48%和-53%，组内比较 p<0.001）。只有 R10 组的巨噬细胞密度降低（-23%，p=0.04）和微血管减少（-12%，p=0.002）。R10 组总动脉粥样硬化体积减少（109.2±62.1mm 至 101.8±61.1mm 至 102.5±62.2mm，p=0.047），但 A20 组无变化（83.3±48.5mm 至 77.6±43.0mm 至 77.9±48.6mm，p=0.07）。总之，尽管两种他汀类药物均显示出相似的血脂谱降低，但与阿托伐他汀组相比，瑞舒伐他汀组显示出更快和更强的斑块稳定和斑块体积消退。
