Comparison of intensive and low-dose atorvastatin therapy in the reduction of carotid intimal–medial thickness in patients with coronary heart disease
- Cheuk-Man Yu1,
- Qing Zhang1,
- Linda Lam2,
- Hong Lin1,
- Shun-Ling Kong1,
- Wilson Chan1,
- Jeffrey Wing-Hong Fung1,
- Kenny K K Cheng1,
- Iris Hiu-Shuen Chan3,
- Stephen Wai-Luen Lee2,
- John E Sanderson4,
- Christopher Wai-Kei Lam5
- 1Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- 2Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
- 3Department of Cardiology, City General Hospital, Stoke-on-Trent, UK
- 4Department of Cardiovascular Medicine, The Medical School, University of Birmingham, Edgbaston, Birmingham, UK
- 5Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
- Correspondence to:
Professor C-M Yu
Division of Cardiology, SH Ho Cardiovascular and Stroke Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong;
- Accepted 23 January 2007
- Published Online First 7 March 2007
Background: Intensive statin therapy has been shown to improve prognosis in patients with coronary heart disease (CHD). It is unknown whether such benefit is mediated through the reduction of atherosclerotic plaque burden.
Aim: To examine the efficacy of high-dose atorvastatin in the reduction of carotid intimal–medial thickness (IMT) and inflammatory markers in patients with CHD.
Design: Randomised trial.
Setting: Single centre.
Patients: 112 patients with angiographic evidence of CHD.
Interventions: A high dose (80 mg daily) or low dose (10 mg daily) of atorvastatin was given for 26 weeks.
Main outcome measures: Carotid IMT, C-reactive protein (CRP) and proinflammatory cytokine levels were assessed before and after therapy.
Results: The carotid IMT was reduced significantly in the high-dose group (left: mean (SD), 1.24 (0.48) vs 1.15 (0.35) mm, p = 0.02; right: 1.12 (0.41) vs 1.01 (0.26) mm, p = 0.01), but was unchanged in the low-dose group (left: 1.25 (0.55) vs 1.20 (0.51) mm, p = NS; right: 1.18 (0.54) vs 1.15 (0.41) mm, p = NS). The CRP levels were reduced only in the high-dose group (from 3.92 (6.59) to 1.35 (1.83) mg/l, p = 0.01), but not in the low-dose group (from 2.25 (1.84) to 3.36 (6.15) mg/l, p = NS). A modest correlation was observed between the changes in carotid IMT and CRP (r = 0.21, p = 0.03).
Conclusions: In patients with CHD, intensive atorvastatin therapy results in regression of carotid atherosclerotic disease, which is associated with reduction in CRP levels. On the other hand, a low-dose regimen only prevents progression of the disease.
- CHD, coronary heart disease
- CRP, C-reactive protein
- HDL, high-density lipoprotein
- IMT, intimal–medial thickness
- IL, interleukin
- LDL, low-density lipoprotein
- TNF-α, tumour necrosis factor α
Published Online First 19 February 2007