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EASY-FIT: High-dose atorvastatin provided increase in fibrous cap thickness in coronary plaques
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In the EASY-FIT study, atorvastatin 20 mg per day provided a greater increase in fibrous cap thickness in coronary atherosclerotic plaques at 12 months than atorvastatin 5 mg per day.
Kenichi Komukai, MD, and colleagues assessed the effect of atorvastatin dose on fibrous cap thickness in coronary atherosclerotic plaques because the precise mechanism of plaque stabilization by statin therapy was not known. They performed intravascular optical coherence tomography at baseline and at 12 months to assess intermediate nonculprit lesions in 70 patients (mean age, 66 years; 80% men) with unstable angina pectoris and untreated dyslipidemia who were randomly assigned to daily atorvastatin 20 mg or 5 mg.
“Because catheter examination can be performed repeatedly over sequential time points, intravascular imaging seems to be an optimal means of assessing serial changes in coronary plaque vulnerability and elucidating plaque-stabilizing mechanisms of lipid-lowering therapy with statins,” Komukai, from the department of cardiovascular medicine at Wakayama Medical University in Japan, and colleagues wrote.
At 12 months, in the 60 patients not excluded from analysis, serum LDL was lower in the atorvastatin 20-mg group (69 mg/dL vs. 78 mg/dL; P=.039). In addition, the increase in fibrous cap thickness was greater in the atorvastatin 20-mg group (69% vs. 17%; P<.001).
According to the researchers, increase in fibrous cap thickness correlated with decrease in serum LDL (P<.001), malondialdehyde-modified LDL (P=.029), high-sensitivity C-reactive protein (P=.033), matrix metalloproteinase-9 (P<.001) and grade of OCT-derived macrophages (P=.003).
“Overall, these findings provide strong evidence that high- and moderate-intensity statin therapy might provide greater benefit for plaque stabilization compared with a lower dose regimen,” Komukai and colleagues wrote. “Our results suggest that statin therapy could induce fibrous cap thickening and stabilize coronary plaques through its anti-inflammatory properties.”
Disclosure: The study was funded by Pfizer Japan. The researchers report no relevant financial disclosures.
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