Stabilization of carotid atheroma assessed by quantitative ultrasound analysis in nonhypercholesterolemic patients with coronary artery disease
Stabilization of carotid atheroma assessed by quantitative ultrasound analysis in nonhypercholesterolemic patients with coronary artery disease
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DOI：
10.1016/j.jacc.2005.04.070
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发表时间：
2005-12-06
影响因子：
24
通讯作者：
Ogawa, H
中科院分区：
文献类型：
--
作者：
Watanabe, K;Sugiyama, S;Ogawa, H
本研究旨在探讨是否强化降胆固醇治疗与他汀类药物在nonhypercholesterolemic患者是有效的，在改善回声的易损斑块超声评估与积分背向散射（IBS）analysis.Background动脉粥样硬化斑块稳定是一个有前途的临床策略，以防止心血管事件的患者冠状动脉疾病（CAD）。冠状动脉和颈动脉斑块的不稳定性之间存在相关性，回声斑块被认为是易损斑块。方法连续性非高胆固醇血症的CAD患者被随机分配成人治疗面板III饮食疗法（饮食组; n = 30）或普伐他汀（他汀组; n = 30）。通过IBS测量内膜中层厚度（IMT）和回声强度来监测无回声颈动脉斑块，持续六个月。结果他汀类药物组总胆固醇、低密度脂蛋白胆固醇（LDL-C）和高敏C反应蛋白显着降低（从197 +/- 15 mg/dl至170 +/- 18 mg/dl [p < 0.001];从131 +/- 14 mg/dl至99 +/- 14 mg/dl [p < 0.001]; 0.11 [0.04 - 0.22] mg/dl至0.06 [0.04 - 0.11] mg/dl [p < 0.05];分别地），而只有总胆固醇适度降低（从193 +/-24 mg/dl到185 +/-22 mg/dl [p < 0.05]），并且在饮食组中LDL-C和甘油三酯不显著地降低。他汀类药物组颈动脉斑块回声强度显著增加，而饮食组无此现象（从-18.5 +/- 4.1 dB至-15.9 +/- 3.7 dB [p < 0.001]和从-18.2 +/- 4.0 dB至-18.9 +/- 3.5 dB [p = 0.13];结论他汀类药物治疗能迅速有效地增加非高胆固醇血症冠心病患者易损斑块的回声强度，而不影响斑块大小。超声结合IBS对颈动脉斑块质量的定量评估，可通过评估动脉粥样硬化的易损性来监测动脉粥样硬化病变。
OBJECTIVES This study examined whether intensive cholesterol-lowering therapy with statins in nonhypercholesterolemic patients is effective in improving echolucency of vulnerable plaques assessed by ultrasound with integrated backscatter (IBS) analysis.BACKGROUND Atherosclerotic plaque stabilization is a promising clinical strategy to prevent cardiovascular events in patients with coronary artery disease (CAD). There is a correlation between coronary and carotid plaque instability, and echolucent plaques are recognized as vulnerable plaques.METHODS Consecutive nonhypercholesterolemic patients with CAD were randomly assigned Adult Treatment Panel-III diet therapy (diet group; n = 30) or pravastatin (statin group; n = 30). Echolucent carotid plaques were monitored by measuring intima-media thickness (IMT) and echogenicity by IBS for six months.RESULTS Total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-sensitivity C-reactive protein were significantly decreased in the statin group (from 197 +/- 15 mg/dl to 170 +/- 18 mg/dl [p < 0.001]; from 131 +/- 14 mg/dl to 99 +/- 14 mg/dl [p < 0.001]; and from 0.11 [0.04 to 0.22] mg/dl to 0.06 [0.04 to 0.11] mg/dl [p < 0.05]; respectively), whereas only total cholesterol was moderately reduced (from 193 +/- 24 mg/dl to 185 +/- 22 mg/dl [p < 0.05]) and LDL-C and triglycerides insignificantly reduced in the diet group. Significant increases of echogenicity of carotid plaques were noted in the statin group but not in the diet group (from -18.5 +/- 4.1 dB to -15.9 +/- 3.7 dB [p < 0.001] and from -18.2 +/- 4.0 dB to -18.9 +/- 3.5 dB [p = 0.13]; respectively) without significant regression of plaque-IMT values in both groups.CONCLUSIONS Statin therapy is rapidly effective in increasing echogenicity of vulnerable plaques without regression of plaque size in nonhypercholesterolemic patients with CAD. Quantitative assessment of carotid plaque quality by ultrasound with IBS is clinically useful for monitoring atherosclerotic lesions by evaluating vulnerability of atheroma.