Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

Author:

Achenbach Stephan1,Ropers Dieter1,Pohle Karsten1,Leber Alexander1,Thilo Christian1,Knez Andreas1,Menendez Theresa1,Maeffert Ralph1,Kusus Magda1,Regenfus Matthias1,Bickel Andrea1,Haberl Ralph1,Steinbeck Gerhard1,Moshage Werner1,Daniel Werner G.1

Affiliation:

1. From the Department of Internal Medicine II (S.A., D.R., K.P., T.M., R.M., M.K., M.R., A.B., W.G.D.), University of Erlangen-Nürnberg, Germany and Department of Internal Medicine I (A.L., C.T., A.K., R.H., G.S., W.M.), Ludwig-Maximilian-University Munich, Germany.

Abstract

Background— Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. Methods and Results— In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol >130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164±30 to 107±21 mg/dL. The median calcified volume was 155 mm 3 (range, 15 to 1849) at baseline, 201 mm 3 (19 to 2486) after 14 months without treatment, and 203 mm 3 (15 to 2569) after 12 months of cerivastatin treatment. The median annualized absolute increase in coronary calcium was 25 mm 3 during the untreated versus 11 mm 3 during the treatment period ( P =0.01). The median annual relative increase in coronary calcium was 25% during the untreated versus 8.8% during the treatment period ( P <0.0001). In 32 patients with an LDL cholesterol level <100 mg/dL under treatment, the median relative change was 27% during the untreated versus −3.4% during the treatment period ( P =0.0001). Conclusions— Treatment with the cholesterol synthesis enzyme inhibitor cerivastatin significantly reduces coronary calcium progression in patients with LDL cholesterol >130 mg/dL.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

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