Am J Cardiovasc Dis 2012;2(2):84-88

Original Article
Rapid changes in plaque composition and morphology after intensive lipid
lowering therapy: study with serial coronary CT angiography

Masaya Shimojima, Masa-aki Kawashiri, Yutaka Nitta, Taiji Yoshida, Shouji Katsuda, Bunji Kaku, Tomio Taguchi, Akira
Hasegawa, Tetsuo Konno, Kenshi Hayashi, Masakazu Yamagishi

Division of Cardiology, Toyama Red Cross Hospital, Toyama, Japan; Division of Cardiovascular Medicine, Kanazawa
University Graduate School of Medicine, Kanazawa, Japan 

Received March 28, 2012; accepted April 25, 2012; Epub May 15, 2012; published June 15, 2012

Abstract: Although intensive lipid lowering by statins can enhance plaque stability, few data exist regarding how early
statins change plaque composition and morphology in clinical setting. Therefore, to examine early changes in plaque
composition and morphology by intensive lipid lowering by statins, we evaluate coronary plaques from acute coronary
syndrome (ACS) before and 3 weeks after lipid lowering by coronary CT angiography. We enrolled 110 patients with
suspected ACS and underwent coronary CT. We defined plaque as unstable when CT number of plaque< 50HU and
remodeling index (lesion diameter/reference diameter) >1.10. Rosuvastatin (5 mg/day) or atorvastatin (20 mg/day) were
introduced to reduce low density lipoprotein cholesterol (LDL-C). Then, CT was again performed by the same condition 3
weeks after lipid lowering therapy. Total 10 patients (8 men, mean age 72.0 years), in whom informed consent regarding
serial CT examination was obtained, were analyzed. Among them, 4 patients who denied to have intensive lipid lowering
were served as controls. In remaining 6 patients, LDL-C reduced from 129.5±26.9 mg/dl to 68.5±11.1 mg/dl after statin
treatment. Under these conditions, CT number of the targeted plaque significantly increased from 16.0±15.9 to 50.8±35.0
HU (p<0.05) and remodeling index decreased from 1.22±0.11 to 1.11±0.06 (p<0.05), although these values substantially
unchanged in controls. These results demonstrate that MDCT-determined plaque composition as well as volume could be
changed within 3 weeks after intensive lipid lowering. This may explain acute effects of statins in treatment of acute
coronary syndrome. (AJCD1203006).

Keywords: Computed tomography, HMG-CoA reductase inhibitor, Plaques, Unstable coronary syndrome

Address all correspondence to:
Dr. Masakazu Yamagishi
Professor of Medicine, and Chief, Medicine
Kanazawa University Graduate School of Medicine
13-1 Takara-machi, Kanazawa, Ishikawa 9208641, Japan.
Tel: 81-76-265-2259; Fax: 81-76-234-4210
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