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Effect of Fluvastatin on Progression of Coronary Atherosclerotic Plaque Evaluated by Virtual Histology Intravascular Ultrasound

Kenya Nasu, MD^_*,_*, Etsuo Tsuchikane, MD, PhD^_*, Osamu Katoh, MD^_*, Nobuyoshi Tanaka, MD^_*, Masashi Kimura, MD^_*, Mariko Ehara, MD^_*, Yoshihisa Kinoshita, MD^_*, Tetsuo Matsubara, MD^_*, Hitoshi Matsuo, MD^_*, Keiko Asakura, MD^_*, Yasushi Asakura, MD^_*, Mitsuyasu Terashima, MD^_*, Tadateru Takayama, MD, Junko Honye, MD, Atsushi Hirayama, MD, Satoshi Saito, MD, Takahiko Suzuki, MD, PhD^_*

^_* Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
Department of Cardiology, Nihon University Itabashi Hospital, Tokyo, Japan

^_* Reprint requests and correspondence: Dr. Kenya Nasu, Department of Cardiology, Toyohashi Heart Center, 21-1, Gobudori, Oyama, Toyohashi, Aichi 441-8530, Japan (Email: nasu{at}heart-center.or.jp).

Objectives: The aim of this study was to evaluate the effect of treatment with statins on the progression of coronary atherosclerotic plaques of a nonculprit vessel by serial volumetric virtual histology (VH) intravascular ultrasound (IVUS).

Background: Recent clinical trials have demonstrated a reduction of atherosclerotic plaque, yet whether statin therapy affects the change in components of plaque remains unknown.

Methods: This study was a nonrandomized and nonblinded design. Eighty patients with stable angina pectoris were divided into either the fluvastatin group (n = 40) or the control group (n = 40) according to their total or low-density lipoprotein (LDL) cholesterol level. The volume of each plaque component (dense calcium, fibrous tissue, fibro-fatty, or necrotic core) was evaluated at baseline and at 12-month follow-up.

Results: The LDL cholesterol and high-sensitivity C-reactive protein (hsCRP) levels in the fluvastatin group were significantly decreased at time of follow-up. In VH IVUS findings, fibro-fatty volume was significantly decreased (baseline 80.1 ± 57.9 mm³ vs. follow-up 32.5 ± 27.7 mm³, p < 0.0001) and fibrous tissue volume was increased (baseline 146.5 ± 85.6 mm³ vs. follow-up 163.3 ± 94.5 mm³, p < 0.0001) in the fluvastatin group. In the control group, the volumes of all plaque components without fibrous tissue were significantly increased. Change in fibro-fatty volume has a significant correlation with a change in LDL cholesterol level (R = 0.703, p < 0.0001) and change in hsCRP level (R = 0.357, p = 0.006).

Conclusions: One-year lipid-lowering therapy by fluvastatin showed significant regression of plaque volume and alterations in atherosclerotic plaque composition with a significant reduction of fibro-fatty volume.

Key Words: atherosclerosis • imaging • lipids • lipoprotein • plaque

Abbreviations and Acronyms   EEM = external elastic membrane   hsCRP = high-sensitivity C-reactive protein   IVUS = intravascular ultrasound   LDL = low-density lipoprotein   VH = Virtual Histology

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