The effect of different loading doses of atorvastatin in patients with stable plaques

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Objective To investigate the effect of different loading doses of atorvastatin in patients with stable plaques.Methods Consecutive 174 patients with stable plaque who underwent coronary arteriongraphy (CAG) and intravascular unltrasound(IVUS) were randomly assigned to receive 10 mg atorvastatin treatment (group 10 mg,n =47),20 mg atorvastatin treatment(group 20 mag,n =45),40 mg atorvastatin treatment (group 40 mg,n =43) and 80 mg atorvastatin treatment (group 80 mg,n =39).The endpoints including low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol (HDL-C),high-sensitivity C-reactive protein (hs-CRP) levels,necrotic and plaque volumes,were assessed after 3-6 months' follow-up.Results Mean LDL-C,HDL-C,hs-CRP,the percentage of necrotic,plaques volumes were similar at baseline (P ＞ 0.05).During 3-6 months of follow up:(1)LDL-C levels in group 10 mg,20 mg,40 mg,80 mg were lower than at baseline (t =3.12,4.23,3.26 and 5.21 respectively,P ＜ 0.01).There was significant difference between the 20 mg group and the 40 mg group(P ＜ 0.05) ; (2) There was no significant difference of HDL-C levels in 10 mg,20 mg and 40 mg groups after atorvastatin treatment.However,its level was significantly higher in the 80 mg group after atorvastatin treatment than other dose groups(P ＜ 0.05) and were higher than at baseline(t =2.35,P ＜ 0.01) ;(3)the 80 mg group's hs-CRP levels decreased significantly after treatment than at baseline((3.59 + 1.07)mg/L vs (6.10 + 2.12) mg/L,t =2.37,P ＜ 0.01);(4)According to the VH of IVUS,the percentage of necrotic in 10 mg group became higher than at baseline ((16.54 + 1.76) ％ vs.(7.83 + 1.03) ％,t =2.38,P ＜0.01) and conformed to unstable plaques diagnostic criteria(＞ 10％).There was no significant difference in group 20 mg,40 mg and 80 mg with at baseline (t =1.24,0.21,0.69 respectively,P =0.069,0.846,0.643respectively) ; (5)Plaques volumes in group 10 mg,20 mg were not larger than at baseline.However,in group 40mg and 80 mg.Plaques volumes were smaller than at baseline ((30.69 ± 8.12) mm3 vs (37.09 + 12.01)mm3,t=l.29,P=0.019;(24.99±l.01) mm3 vs (36.47+14.68) mm3,t =2.62,P＜0.01).Conclusion The effects of atorvastatin on stable plaques vary with doses.(1) For LDL-C,the use of atorvastation 20 mg/d can make LDL-C reaching standard,and atorvastation 40 mg/d was superior to 20 mg/d and similar to 80 mg/d.(2)For HDL-C,atorvastation 80 mg/d can make it higher.(3)Atorvastation 80 mg/d can make hs-CRP lower.(4)Atorvastation≥20 mg/d can make plaques stable and atorvastation 80 mg/d was superior to 20 mg/d and 40mg/d.Atorvastation 40-80 mg/d can make plaques dwindled. Key words: Stable plaques; Atorvastatin; Lipid; High-sensitivity C-reactive protein; Plaque volumes; Virtual histology intravascular ultrasound