Impact of Pitavastatin on Carotid Plaque Regression in Patients with Hypercholesterolemia

Pitavastatin is a novel 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor with pleiotropic anti-atherosclerotic effects, but there is little evidence on the effects of pitavastatin treatment in inducing carotid atherosclerosis regression in patients with hypercholesterolemia (HC).

A self-controlled multicenter clinical trial of with HC was conducted between October 2018 to November 2020, to assess whether pitavastatin therapy could slow the progression and/or cause regression of carotid atherosclerosis, as determined by carotid ultrasound. Pitavastatin 2 mg/d was given to all patients for 1 month and then increased to 4 mg/d for 11 months. Ezetimibe 10 mg per day was added from the fourth month onward for high-risk and very high-risk patients who did not reach the targets of low-density lipoprotein cholesterol (LDL-C). Carotid ultrasonography and biological exams was used to assess the carotid atheroma burden at baseline and after 12 months of treatment. At the final follow-up visit, a questionnaire was administered to collect information on patients' medication use in order to assess treatment compliance.

The baseline LDL-C level of 188 patients dropped from 4.06 ± 0.60 mmol/L to 2.46 ± 0.73 mmol/L with a mean reduction of 39.4% (P < 0.001). The pitavastatin-based lipid-lowering treatment significantly reduced plaque thickness by 4.0% (P = 0.003), longitudinal thickness by 2.7% (P = 0.018) and plaque length by 5.0% (P = 0.002) from the baseline.

The pitavastatin-based lipid-lowering treatment resulted in statistically significant regression of carotid atherosclerotic plaques. More research is needed to determine the effects of the observed changes on clinical outcomes.