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Prevention of atherosclerosis progression using atorvastatin in normolipidemic coronary artery disease patients--a
Anand Shukla1, Mukesh K Sharma, Alkesh Jain
1Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow.
Insights
Low-dose statins effectively reduced atherosclerosis progression in Indian patients with normal cholesterol levels, as measured by carotid intima media thickness. This therapy shows promise for patients with coronary heart disease and average or below-average lipid profiles.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- High-dose statins are effective in reducing atherosclerosis progression in hypercholesterolemic patients.
- A significant portion of Indian patients develop coronary artery disease (CAD) with normal or below-average cholesterol levels.
- Limited data exists on the efficacy of low-dose statins in this specific patient population.
Purpose of the Study:
- To investigate the effect of low-dose atorvastatin on the progression of atherosclerosis in Indian patients with CAD and normal lipid levels.
- To assess changes in carotid intima media thickness (CIMT) as a surrogate marker for atherosclerosis progression.
- To evaluate the lipid-lowering effects and safety of low-dose statin therapy in this cohort.
Main Methods:
- A prospective, randomized study involving 150 Indian patients with angiographically proven CAD and baseline cholesterol <200 mg/dl.
- Patients were randomized to receive either low-dose atorvastatin (10 mg) or a placebo for one year.
- Carotid intima media thickness was measured using B-mode ultrasound at baseline and after one year to assess atherosclerosis progression.
Main Results:
- Low-dose atorvastatin significantly decreased mean maximum CIMT in all measured carotid segments compared to placebo.
- The average CIMT showed a decrease in the atorvastatin group (-0.013 mm) and an increase in the placebo group (+0.009 mm) (p < 0.001).
- Atorvastatin also led to a significant reduction in total cholesterol and LDL cholesterol, while the placebo group showed an increase.
Conclusions:
- Low-dose statins effectively reduce atherosclerosis progression in Indian patients with CAD and normal lipid levels, independent of significant lipid lowering.
- The observed reduction in CIMT suggests a direct anti-atherosclerotic effect of low-dose statins.
- The study supports the use of low-dose statins in patients with normal or below-average cholesterol levels presenting with coronary heart disease.
Background:
Statins have been known to reduce progression of atherosclerosis when used in high dosage in patients with elevated cholesterol. A large majority of Indian patients, however, develop coronary artery disease with average or below average cholesterol level. There is insufficient data on effect of low-dose statins on progression of atherosclerosis in such patients with normal/average lipid levels.
Methods And Results:
In this prospective study, 150 patients with angiographically proven coronary artery disease and baseline total cholesterol <200 mg/dl and low-density lipoprotein cholesterol <130 mg/dl were randomized to treatment with low-dose atorvastatin (10 mg) or placebo. Both groups were comparable in demographic characteristics. Progression of atherosclerosis was assessed using carotid intima media thickness as surrogate marker using standard protocol on B-mode ultrasound including common carotid artery, common carotid bifurcation and internal carotid artery measurements. Follow-up study for carotid intima media thickness was done at end of one year. A decrease in mean maximum carotid intima media thickness was recorded for all the three carotid segments individually from basal to end of one year in atorvastatin group [common carotid artery -0.008 mm (p = 0.01), common carotid bifurcation-0.022 mm (p = 0.001), internal carotid artery -0.009 mm (p = 0.01)] while the same showed an increase in placebo group [common carotid artery +0.011 mm (p = NS), common carotid bifurcation +0.013 mm (p=NS), internal carotid artery +0.007 mm (p=NS)]. The average mean carotid intima media thickness (all three segments included) decreased from 0.739 +/- 0.114 mm to 0.726 +/- 0.115 mm (difference -0.013 mm) in statin group and increased from 0.733 +/- 0.124 mm to 0.742 +/- 0.117 mm (difference + 0.009 mm) in placebo group (p < 0.001). Along side, there was a reduction in the total cholesterol from 144 +/- 26 mg/dl to 130 +/- 18 mg/dl (decreased arrow 9.7%, p = 0.05) and in low-density lipoprotein cholesterol from 86 +/- 24 mg/dl to 74 +/- 19 mg (decreased arrow 13.9%, p = 0.05) in study group and an increase in total cholesterol from 148 +/- 32 mg/dl to 154 +/- 8 mg/dl (increased arrow 4.05%, p=NS) and in low-density lipoprotein cholesterol from 84 +/- 19 mg/dl to 87 +/- 16 mg/dl (increased arrow 3.57%, p=NS) in placebo group at end of one year (p=NS). No adverse effects of statins were reported in the treatment arm.
Conclusions:
We conclude that low-dose statins reduce progression of atherosclerosis as observed by carotid intima media thickness in Indian patients with known coronary heart disease and normal lipid values independent of lipid lowering. The study favors use of this therapy in patients with normal/below average cholesterol levels.
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