Determinants of arterial wall remodeling during lipid-lowering therapy: serial intravascular ultrasound observations from the Reversal of Atherosclerosis with Aggressive Lipid Lowering Therapy (REVERSAL) trial

Autor: Carolyn Apperson-Hansen, Steven E. Nissen, Kathy Wolski, Tim Crowe, E. Murat Tuzcu, Tammy Churchill, Chaohui Wang, William A. Magyar, Aaron Loyd, Songhua Lin, Stephen J. Nicholls, Ilke Sipahi, Paul Schoenhagen
Rok vydání: 2006
Předmět:
Male
Pathology
Cardiac Catheterization
Coronary Artery Disease
Coronary Angiography
Coronary artery disease
Risk Factors
Intravascular ultrasound
Atorvastatin
Single-Blind Method
Prospective Studies
Pravastatin
medicine.diagnostic_test
biology
Models
Cardiovascular
Arteriosclerosis
Middle Aged
Adaptation
Physiological
Coronary Vessels
C-Reactive Protein
Cholesterol
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Adult
Vasculitis
medicine.medical_specialty
Lumen (anatomy)
Hyperlipidemias
Article
Lesion
Physiology (medical)
medicine
Humans
Pyrroles
Triglycerides
Ultrasonography
Interventional
Aged
business.industry
C-reactive protein
Cholesterol
HDL
Lipid metabolism
Cholesterol
LDL
medicine.disease
Heptanoic Acids
biology.protein
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Lipid profile
business
Follow-Up Studies
Zdroj: Circulation. 113(24)
ISSN: 1524-4539
Popis: Background— Coronary plaque progression and instability are associated with expansive remodeling of the arterial wall. However, the remodeling response during plaque-stabilizing therapy and its relationship to markers of lipid metabolism and inflammation are incompletely understood. Methods and Results— Serial intravascular ultrasound (IVUS) data from the Reversal of Atherosclerosis with Aggressive Lipid Lowering Therapy (REVERSAL) trial were obtained during 18 months of intensive versus moderate lipid-lowering therapy. In a subgroup of 210 patients, focal coronary lesions with mild luminal narrowing were identified. Lumen area, external elastic membrane (EEM) area, and plaque area were determined at the lesion and proximal reference sites at baseline and during follow-up. The remodeling ratio (RR) was calculated by dividing the lesion EEM area by the reference EEM area. The relationship between the change in remodeling, change in plaque area, lipid profile, and inflammatory markers was examined. At the lesion site, a progression in plaque area (8.9±25.7%) and a decrease in the RR (−3.0±11.2%) occurred during follow-up. In multivariable analyses, the percentage change in plaque area ( P P P =0.027), and hypertension at baseline ( P =0.014) showed a significant, direct relation with the RR at follow-up. Lesion location in the right coronary artery ( P =0.006), percentage change in triglyceride levels ( P =0.049), and age ( P =0.037) demonstrated a significant, inverse relation with the RR at follow-up. Changes in LDL cholesterol, HDL cholesterol, and treatment group demonstrated no significant associations. Conclusions— Constrictive remodeling of the arterial wall was observed during plaque-stabilizing therapy with statin medications and appears related to their antiinflammatory effects.
Databáze: OpenAIRE
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