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Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial
T J Smilde1, S van Wissen, H Wollersheim
1Department of Medicine, University Medical Center Nijmegen, Netherlands. t.smilde@worldonline.nl
Insights
Aggressive LDL-cholesterol lowering with atorvastatin reduced carotid intima media thickness in familial hypercholesterolaemia patients. Conventional simvastatin treatment did not show this regression, indicating atorvastatin
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Medical Research
Background:
- High LDL-cholesterol is a significant risk factor for atherosclerosis development.
- Investigating the efficacy of aggressive versus conventional statin therapy for managing this risk is crucial.
- The study specifically examined high-dose atorvastatin's impact on carotid atherosclerosis progression.
Purpose of the Study:
- To compare the effectiveness of aggressive cholesterol lowering with high-dose atorvastatin against conventional simvastatin treatment.
- To determine the impact of these treatments on the progression of carotid atherosclerosis.
Main Methods:
- A randomized, double-blind clinical trial involving 325 patients with familial hypercholesterolaemia.
- Participants received either atorvastatin 80 mg (n=160) or simvastatin 40 mg (n=165) daily.
- The primary endpoint was the change in carotid intima media thickness (IMT) over 2 years, assessed via ultrasound.
Main Results:
- Atorvastatin treatment led to a significant decrease in IMT (-0.031 mm; p=0.0017).
- Simvastatin treatment resulted in a significant increase in IMT (0.036 mm; p=0.0005).
- The difference in IMT change between the groups was statistically significant (p=0.0001), with atorvastatin demonstrating superior LDL-cholesterol reduction.
Conclusions:
- Aggressive LDL-cholesterol reduction using atorvastatin promoted regression of carotid intima media thickness.
- Conventional LDL lowering with simvastatin did not achieve similar regression in patients with familial hypercholesterolaemia.
- These findings highlight the benefit of intensive statin therapy in managing atherosclerosis.
Background:
High LDL-cholesterol is a risk factor for atherosclerosis. We aimed to determine whether aggressive cholesterol lowering with statins was more effective than conventional statin treatment in this disease. We investigated the effect of high-dose atorvastatin on carotid atherosclerosis progression.
Method:
We did a randomised, double-blind clinical trial in 325 patients with familial hypercholesterolaemia. Patients were given either atorvastatin 80 mg (n=160) or simvastatin 40 mg (n=165) daily, on an intent-to-treat basis. The primary endpoint was the change of carotid intima media thickness (IMT), as measured by quantitative B-mode ultrasound, over 2 years.
Findings:
The overall baseline IMT, combining the measurements of the common and internal carotid artery and the carotid bifurcation on both sides, was 0.93 mm (SD 0.22) and 0.92 mm (0.21) in the atorvastatin and simvastatin groups, respectively. After treatment with atorvastatin for 2 years, IMT decreased (-0.031 mm [95% CI -0.007 to -0.055]; p=0.0017), whereas in the simvastatin group it increased (0.036 [0.014-0.058]; p=0.0005). The change in thickness differed significantly between the two groups (p=0.0001). Atorvastatin showed greater reductions in cholesterol concentrations than did simvastatin. HDL-cholesterol concentrations increased in both groups. Both drugs were equally well tolerated.
Interpretation:
Our results show that aggressive LDL-cholesterol reduction by atorvastatin was accompanied by regression of carotid intima media thickness in patients with familial hypercholesterolaemia, whereas conventional LDL lowering was not.
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