Effect of HMG-Coa reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography
Effect of HMG-Coa reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography
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DOI：
10.1056/nejm199812313392703
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发表时间：
1998-12-31
影响因子：
158.5
通讯作者：
Russo, DJ
中科院分区：
文献类型：
--
作者：
Callister, TQ;Raggi, P;Russo, DJ
背景冠状动脉疾病消退的血管造影研究是侵入性的，费用昂贵，并且只能有限地评估动脉粥样硬化疾病程度的变化。电子束计算机断层扫描（CT）是非侵入性和廉价的。整个冠状动脉树可以在一个单一的成像过程中进行研究，冠状动脉钙化的体积与动脉粥样硬化斑块的总负荷密切相关。（男性61%，女性39%;年龄范围，32 - 75岁），无冠状动脉疾病史，由其初级保健医生转诊进行电子束CT筛查。所有患者在至少12个月（范围12 - 15）后进行基线扫描和随访评估，并计算体积钙评分作为斑块总负荷的估计值。由转诊医生酌情决定是否开始使用3-羟基-3-甲基戊二酰辅酶A（HMG-CoA）还原酶抑制剂治疗。低密度脂蛋白（LDL）胆固醇的系列测量，并在钙体积分数的变化与平均LDL cholesterol levels.Results 105例（70%）接受HMG-CoA还原酶抑制剂治疗，44例（30%）没有。随访时，仅在65名最终LDL胆固醇水平低于120 mg/dl（3.10 mmol/L）的治疗患者中观察到钙体积分数的净减少（平均[+/-SD]分数变化，-7+/-23%; P=0.01）。未经治疗的患者平均LDL胆固醇水平至少为120 mg/dl，随访时平均钙体积评分显著增加（平均变化，+52+/-36%; P
Background Angiographic studies of the regression of coronary artery disease are invasive and costly, and they permit only limited assessment of changes in the extent of atherosclerotic disease. Electron-beam computed tomography (CT) is noninvasive and inexpensive. The entire coronary-artery tree can be studied during a single imaging session, and the volume of coronary calcification as quantified with this technique correlates closely with the total burden of atherosclerotic plaque.Methods We conducted a retrospective study of 149 patients (61 percent men and 39 percent women; age range, 32 to 75 years) with no history of coronary artery disease who were referred by their primary care physicians for screening electron-beam CT. All patients underwent base-line scanning and follow-up assessment after a minimum of 12 months (range, 12 to 15), and a volumetric calcium score was calculated as an estimate of the total burden of plaque. Treatment with 3-hydroxy3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors was begun at the discretion of the referring physician. Serial measurements of low-density lipoprotein (LDL) cholesterol were obtained, and the change in the calcium-volume score was correlated with average LDL cholesterol levels.Results One hundred five patients (70 percent) received treatment with HMG-CoA reductase inhibitors, and 44 patients (30 percent) did not. At followup, a net reduction in the calcium-volume score was observed only in the 65 treated patients whose final LDL cholesterol levels were less than 120 mg per deciliter (3.10 mmol per liter) (mean [+/-SD] change in the score, -7+/-23 percent; P=0.01). Untreated patients had an average LDL cholesterol level of at least 120 mg per deciliter and at the time of follow-up had a significant net increase in mean calcium-volume score (mean change, +52+/-36 percent; P