Kadoglou Nikolaos Pe, Khattab Elina, Velidakis Nikolaos, Patsourakos Nikolaos, Lambadiari Vaia
Medical School, University of Cyprus, Cyprus.
Department of Cardiology, "Tzanio" General Hospital of Piraeus, Piraeus, Greece.
Kardiol Pol. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. Epub 2022 Jun 23.
Novel imaging techniques and biomarkers have emerged as surrogate markers of carotid plaque vulnerability. In parallel, statin administration in patients with established carotid atherosclerosis not requiring revascularization has reduced the number of consequent cerebrovascular events. This reduction is not only attributed to the lipid-lowering properties of statins but also to their pleiotropic actions. The present literature review aimed to summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers and propose an alternative approach to their implementation. Moreover, we assessed the perioperative use of statins in patients undergoing carotid revascularization and the impact of aggressive vs. conventional statin therapy. Recent studies using: (1) ultrasound indices of plaque echogenicity; (2) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans for plaque inflammation assessment; or (3)magnetic resonance imaging (MRI) scans quantifying intraplaque hemorrhage, and lipid-rich necrotic core (LRNC) have shown quite promising results in evaluation of carotid plaque vulnerability. Based on those imaging modalities, a growing number of studies have demonstrated a very modest carotid plaque regression due to/induced by statins, while their stabilizing impact is disproportionally higher. Other studies assaying several biomarkers (e.g. inflammation, etc.) have confirmed a statin-induced carotid plaque stabilization. All the aforementioned benefits followed a dose-dependent pattern of statins, on top of the low-density lipoprotein cholesterol (LDL-C) target in current guidelines. In the case of symptomatic patients with carotid atherosclerosis suitable for revascularization, robust evidence implicates a significant statin-related reduction of perioperative cardiovascular risk only in patients undergoing endarterectomy.
新型成像技术和生物标志物已成为颈动脉斑块易损性的替代标志物。与此同时，对于已确诊颈动脉粥样硬化且无需血运重建的患者，使用他汀类药物可减少随后发生的脑血管事件数量。这种减少不仅归因于他汀类药物的降脂特性，还归因于其多效性作用。本综述旨在基于成像方式和生物标志物总结他汀类药物对颈动脉斑块的稳定作用，并提出实施这些作用的另一种方法。此外，我们评估了他汀类药物在接受颈动脉血运重建患者围手术期的使用情况以及强化他汀治疗与常规他汀治疗的影响。最近的研究使用：（1）斑块回声的超声指标；（2）用于评估斑块炎症的氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）；或（3）定量斑块内出血和富含脂质的坏死核心（LRNC）的磁共振成像（MRI）扫描，在评估颈动脉斑块易损性方面显示出相当有前景的结果。基于这些成像方式，越来越多的研究表明，他汀类药物导致的颈动脉斑块消退非常有限，而其稳定作用却相对更强。其他检测多种生物标志物（如炎症等）的研究也证实了他汀类药物可使颈动脉斑块稳定。上述所有益处均遵循他汀类药物的剂量依赖性模式，且超出了现行指南中低密度脂蛋白胆固醇（LDL-C）的目标值。对于适合血运重建的有症状颈动脉粥样硬化患者，有力证据表明仅在接受内膜切除术的患者中，他汀类药物可显著降低围手术期心血管风险。
