Lipid-Lowering and Anti-Inflammatory Benefits of Statin Therapy
More Than Meets the Plaque
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The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely.1 Because the precise mechanisms by which statins exert a survival benefit are incompletely explained by their effect on serum lipids,2 intense efforts have focused on inflammatory effects, both systemically and locally at the plaque itself.
See Article by Kwon et al
In this issue of Circulation: Cardiovascular Imaging, Kwon and Kang et al3 report a post hoc analysis of the prospective, single-center STABLE (Statin and Atheroma Vulnerability Evaluation) trial,4 in which patients in Seoul, Korea underwent invasive coronary angiography with intravascular ultrasound (IVUS) at baseline and 12 months following 1:2 randomization to rosuvastatin 10 mg versus 40 mg daily. Only those patients (n=312) with coronary stenoses defined by virtual histology (VH)-IVUS as fibroatheroma-containing lesions were enrolled, and 225 patients completed the protocol. The primary report of the STABLE trial concluded that patients on either dose of rosuvastatin demonstrated lesions with reduced frequencies of thin-cap fibroatheroma (TCFA), decreased percent necrotic core volume, and increased percent fibrofatty volume on follow-up evaluation.4
In the current analysis, investigators explored the relationship between the changes observed in VH-IVUS-defined characteristics of index plaque with 2 critical biomarkers, low-density lipoprotein cholesterol …