Effect of Intensive and Standard Pitavastatin Treatment With or Without Eicosapentaenoic Acid on Progression of Coronary Artery Calcification Over 12 Months - Prospective Multicenter Study
Effect of Intensive and Standard Pitavastatin Treatment With or Without Eicosapentaenoic Acid on Progression of Coronary Artery Calcification Over 12 Months - Prospective Multicenter Study
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DOI：
10.1253/circj.cj-17-0419
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发表时间：
2018-02-01
影响因子：
3.3
通讯作者：
Ito, Hiroshi
中科院分区：
文献类型：
--
作者：
Miyoshi, Toru;Kohno, Kunihisa;Ito, Hiroshi
背景：降脂药对冠状动脉钙化（CAC）进展的影响尚不清楚。我们评估了匹伐他汀2毫克/天（PIT 2），匹伐他汀4毫克/天（PIT 4），和PIT 2与二十碳五烯酸（PIT 2 +EPA）联合对CAC progression.Methods和Results的影响：这项前瞻性多中心研究在日本包括患者的Agatston评分为1-999，高胆固醇血症，没有证据表明心血管疾病。患者被分配到PIT 2、PIT 4或PIT 2 +EPA组。主要结果是所有患者的Agatston评分的年度百分比变化。总共有156名患者接受了多探测器行计算机断层扫描，没有任何伪影，被纳入主要分析。匹伐他汀未显著降低Agatston评分的年进展率（40%; 95% CI：19-61%）。PIT 2组的Agatston评分年进展率与PIT 4组（分别为34% vs. 42%; P=0.88）或PIT 2 +EPA组（分别为34% vs. 44%; P=0.80）无显著差异。在事后分析中，低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的基线比值是匹伐他汀治疗后Agatston评分无进展的显著预测因子（OR，2.17; 95%CI：1.10-44.12; P=0.02）。与标准治疗相比，强化匹伐他汀治疗和EPA标准治疗并不能减少CAC的进展。
Background: The effect of lipid-lowering agents on progression of coronary artery calcification (CAC) remains unclear. We evaluated the effects of pitavastatin 2 mg/day (PIT2), pitavastatin 4 mg/day (PIT4), and PIT2 combined with eicosapentaenoic acid (PIT2+EPA) on CAC progression.Methods and Results: This prospective multicenter study in Japan included patients with an Agatston score of 1-999, hypercholesterolemia, and no evidence of cardiovascular disease. Patients were allocated into PIT2, PIT4, or PIT2+EPA groups. The primary outcome was the annual percent change in Agatston score in all patients. In total, 156 patients who had multi-detector row computed tomography without any artifacts were included in the primary analysis. Pitavastatin did not significantly reduce the annual progression rate of the Agatston score (40%; 95% CI: 19-61%). The annual progression rate of Agatston score in the PIT2 group was not significantly different from that in the PIT4 group (34% vs. 42%, respectively; P=0.88) or the PIT2+EPA group (34% vs. 44%, respectively; P=0.80). On post-hoc analysis the baseline ratio of low-to high-density lipoprotein cholesterol was a significant predictor of non-progression of Agatston score by pitavastatin (OR, 2.17; 95% CI: 1.10-44.12; P=0.02).Conclusions: Pitavastatin does not attenuate progression of CAC. Intensive pitavastatin treatment and standard treatment with EPA does not reduce progression of CAC compared with standard treatment.