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Comparison of Intensive and Low-dose Atorvastatin Therapy in the Reduction of Carotid Intimal-Medial Thickness in Patients With Coronary Heart Disease
  1. Cheuk-Man Yu (cmyu{at}cuhk.edu.hk)
  1. The Chinese University of Hong Kong, Hong Kong
    1. Qing Zhang
    1. The Chinese University of Hong Kong, Hong Kong
      1. Linda Lam
      1. Queen Mary Hospital, Hong Kong
        1. Hong Lin
        1. The Chinese University of Hong Kong, Hong Kong
          1. Shun-Ling Kong
          1. The Chinese University of Hong Kong, Hong Kong
            1. Wilson Chan
            1. The Chinese University of Hong Kong, Hong Kong
              1. Jeffrey WH Fung
              1. The Chinese University of Hong Kong, Hong Kong
                1. Kenny KK Cheng
                1. The Chinese University of Hong Kong, Hong Kong
                  1. Iris HS Chan
                  1. The Chinese University of Hong Kong, Hong Kong
                    1. Stephen WL Lee
                    1. The Chinese University of Hong Kong, Hong Kong
                      1. John E Sanderson
                      1. Keele University Medical School, City General Hospital, Stoke on Trent, United Kingdom
                        1. Christopher WK Lam
                        1. The Chinese University of Hong Kong, Hong Kong

                          Abstract

                          Objective Intensive statin therapy has been shown to improve prognosis in patients with coronary heart disease (CHD). It is unknown if such benefit is mediated through the reduction of atherosclerotic plaque burden. This study was designed 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 Randomized 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) atorvastatin was given for 26 weeks.

                          Main outcome measures Carotid IMT, C-reactive protein (CRP) and pro-inflammatory cytokine levels were assessed before and after the therapy.

                          Results The carotid IMT was reduced significantly in the high-dose group (left: 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 only reduced in the high-dose group (3.92±6.59 to 1.35±1.83 mg/L, P =0.01), but not the low-dose group (2.25±1.84 to 3.36±6.15 mg/L, P = NS). A modest correlation between the changes in carotid IMT and CRP was observed (r=0.21, P = 0.03).

                          Conclusions In patients with CHD, intensive atorvastatin therapy resulted in the regression of carotid atherosclerotic disease, which was associated with reduction in CRP levels. On the other hand, a low-dose regimen only prevented the progression of the disease.

                          • Lipid-lowering
                          • carotid ultrasound
                          • coronary heart disease
                          • statin

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