• Kenichi Komukai, Takashi Kubo, Hironori Kitabata, Yoshiki Matsuo, Yuichi Ozaki, Shigeho Takarada, Yasushi Okumoto, Yasutsugu Shiono, Makoto Orii, Kunihiro Shimamura, Satoshi Ueno, Takashi Yamano, Takashi Tanimoto, Yasushi Ino, Tomoyuki Yamaguchi, Hirata Kumiko, Atsushi Tanaka, Toshio Imanishi, Hideharu Akagi, and Takashi Akasaka.
• Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
• J. Am. Coll. Cardiol. 2014 Dec 2;64(21):2207-17.

BackgroundThe detailed mechanism of plaque stabilization by statin therapy is not fully understood.ObjectivesThe aim of this study was to assess the effect of lipid-lowering therapy with 20 mg/day of atorvastatin versus 5 mg/day of atorvastatin on fibrous cap thickness in coronary atherosclerotic plaques by using optical coherence tomography (OCT).MethodsSeventy patients with unstable angina pectoris and untreated dyslipidemia were randomized to either 20 mg/day or 5 mg/day of atorvastatin therapy. OCT was performed to assess intermediate nonculprit lesions at baseline and 12-month follow-up.ResultsSerum low-density lipoprotein cholesterol level was significantly lower during therapy with 20 mg/day compared with 5 mg/day of atorvastatin (69 mg/dl vs. 78 mg/dl; p = 0.039). The increase in fibrous cap thickness was significantly greater with 20 mg/day compared with 5 mg/day of atorvastatin (69% vs. 17%; p < 0.001). The increase in fibrous cap thickness correlated with the decrease in serum levels of low-density lipoprotein cholesterol (R = -0.450; p < 0.001), malondialdehyde-modified low-density lipoprotein (R = -0.283; p = 0.029), high-sensitivity C-reactive protein (R = -0.276; p = 0.033), and matrix metalloproteinase-9 (R = -0.502; p < 0.001), and the decrease in grade of OCT-derived macrophages (R = -0.415; p = 0.003).ConclusionsAtorvastatin therapy at 20 mg/day provided a greater increase in fibrous cap thickness in coronary plaques compared with 5 mg/day of atorvastatin. The increase of fibrous cap was associated with the decrease in serum atherogenic lipoproteins and inflammatory biomarkers during atorvastatin therapy. (Effect of Atorvastatin Therapy on Fibrous Cap Thickness in Coronary Atherosclerotic Plaque as Assessed by Optical Coherence Tomography: The EASY-FIT Study; NCT00700037).Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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