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Atherosclerosis. 2014 Jan;232(1):31-9. doi: 10.1016/j.atherosclerosis.2013.10.007. Epub 2013 Oct 30.

Intensive lipid lowering therapy with titrated rosuvastatin yields greater atherosclerotic aortic plaque regression: Serial magnetic resonance imaging observations from RAPID study.

Author information

1
Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan; Department of Neurology, The Jikei University School of Medicine, Japan.
2
Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan.
3
Division of Anti-aging and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Japan. Electronic address: ayaori@ndmc.ac.jp.
4
Iruma Heart Hospital, Japan.
5
Department of Public Health and Preventive Medicine, National Defense Medical College, Japan.
6
Department of Cardiology, National Hospital Organization Tokyo Medical Center, Japan.
7
Department of Neurology, The Jikei University School of Medicine, Japan.

Abstract

OBJECTIVE:

Although previous randomized clinical trials established a basis for lipid guidelines worldwide, they employed fixed doses of statins throughout trials (fire-and-forget approach). In the real clinical setting, however, statin doses are titrated to achieve target low-density lipoprotein cholesterol (LDL-C) levels (treat-to-target approach). The major objective was to investigate whether intensive lipid-lowering therapy using the treat-to-target approach yielded greater regression of aortic plaques.

METHODS:

We therefore performed a prospective, randomized trial comparing the effects of standard (achieve LDL-C levels recommended by the Japanese guidelines) and intensive (achieve 30% lower LDL-C levels than standard) rosuvastatin therapy for 1 year in 60 hypercholesterolemic patients with a primary endpoint of aortic atherosclerotic plaques evaluated by non-invasive magnetic resonance imaging (MRI).

RESULTS:

Average doses were 2.9 ± 3.1 and 6.5 ± 5.1 mg/day for standard (n = 29) and intensive therapy group (n = 31), respectively. Although both therapies significantly reduced LDL-C and high-sensitivity C-reactive protein (hsCRP) levels, LDL-C reduction was significantly greater in the intensive group (-46 vs. -34%). MRI study showed that thoracic aortic plaques were significantly regressed in both groups, with greater regression of thoracic plaque in the intensive group (-9.1 vs. -3.2%, p = 0.01). Multivariate analyses revealed that thoracic plaque regression was significantly correlated with hsCRP reduction, but not with changes in serum lipids, endothelial function, or doses of rosuvastatin.

CONCLUSION:

Intensive statin therapy with titration targeting lower LDL-C levels resulted in greater thoracic aortic plaque regression compared to standard therapy, which was correlated with hsCRP reduction, suggesting that intensive statin therapy could provide better clinical outcomes.

KEYWORDS:

Aortic plaques; Intensive therapy; MRI; Titration of rosuvastatin; hsCRP

[Indexed for MEDLINE]

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