Abstract
While the use of statins in treating patients with atherosclerosis is an undisputed success, the questions regarding an optimal starting time for treatment and its strength remain open. We proposed in our earlier paper published in Int. J. Mol. Sci. (2019, 20) that the growth of intima-media thickness of the carotid artery follows an S-shape (i.e., logistic) curve. In our subsequent paper in PLoS ONE (2020, 15), we incorporated this feature into a logistic control-theoretic model of atherosclerosis progression and showed that some combinations of patient age and intima-media thickness are better suited than others to start treatment. In this study, we perform a new and comprehensive calibration of our logistic model using a recent clinical database. This allows us to propose a procedure for inferring an optimal age to start statin treatment for a particular group of patients. We argue that a decrease in the slope of the IMT logistic growth curve, induced by statin treatment, is most efficient where the curve is at its steepest, whereby the efficiency means lowering the future IMT levels. Using the procedure on an aggregate group of severely sick men, 38 years of age is observed to correlate with the steepest point of the logistic curve, and, thus, it is the preferred time to start statin treatment. We believe that detecting the logistic curve’s steepest fragment and commencing statin administration on that fragment are courses of action that agree with clinician intuition and may support decision-making processes.
Highlights
Knowledge of the intima-media (IMT) growth process is essential for decision making regarding statin therapy initiation and intensification
With the help of new data, we aim to confirm the logistic growth of Intima-Media Thickness (IMT) and establish the steepest fragment on an IMT growth model
On balance, for small root mean square error (RMSE) versus small R2, the logistic curve in Figure 2 supports the conjecture of the authors of [1] regarding the S-shaped process of the IMT growth
Summary
Knowledge of the intima-media (IMT) growth process is essential for decision making regarding statin therapy initiation and intensification. There are studies that have presented a discrepancy between carotid IMT changes, prognosis, and the course of cardiovascular pathologies [13,14], the overwhelming clinical data (see [15,16,17,18,19]) strongly confirm that the IMT will continue to be used as a valuable tool in clinical research. It was conjectured in [1] that the IMT growth process follows an S-shape (i.e., logistic) curve. Remarks and an Appendix, which contains a few summary statistics concerning the observations gathered in the database
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