Abstract 3330: Effect of Achieved Low-density Lipoprotein Cholesterol Level by Atorvastatin on Stabilization of Coronary Plaques - Results from TWINS study

Abstract

Background We have previously reported the stabilization and regression of coronary plaque by atorvastatin using both angioscopy and IVUS. However, it has not been clarified if plaque stabilization is achieved through the reduction of cholesterol level or the direct effect of statin. Then, we analyzed the effect of achieved low-density lipoprotein (LDL) cholesterol level on the stabilization of coronary plaque. Methods Twenty-nine patients with hypercholesterolemia and coronary heart disease were studied. They received lipid-lowering therapy with atorvastatin (10 –20 mg/day) for 80 weeks and were divided into 2 groups by the achieved LDL cholesterol level at 80-week follow up (low LDL group: LDL cholesterol < median value, and high LDL group: LDL cholesterol ≥ median value). Angioscopic examination was performed before and after 80 weeks treatment with atorvastatin. Angioscopic findings of coronary yellow plaque characteristics were divided into six grades (grade 0 to 5) to evaluate vulnerability of plaques; and the mean grade of each patient was evaluated. Results In all 29 patients, LDL cholesterol level was reduced (146.2 to 87.9 mg/dl; p<0.001) and the mean yellow plaque grade was decreased (1.4 to 1.2; p=0.002) at 80-week follow up. LDL cholesterol level was reduced both in low LDL group (140.3 to 75.9 mg/dl; p<0.001) and in high LDL group (151.7 to 99.1 mg/dl; p<0.001). Angioscopic examination showed significant improvement of the grade in low LDL group (1.4 to 1.1; p=0.012) at 80-week follow up, but no significant difference in high LDL group (1.4 to 1.3; p=0.11). Conclusions Lipid-lowering therapy with atorvastatin stabilized coronary plaques, and this effect was larger in the patients LDL cholesterol was reduced more.