Abstract 708: Changes in Carotid Plaque Lipid Content in Subjects Who Continued and Discontinued Statin Therapy
Objective: Changes in carotid plaque lipid-rich necrotic core (LRNC) as assessed by magnetic resonance imaging (MRI) were investigated in subjects who continued and discontinued statin therapy for 2 years after a prospective study.
Methods: The Rosuvastatin Evaluation of Atherosclerotic Chinese Patients (REACH) study in 32 lipid treatment naïve subjects with LRNC showed a significant reduction in LRNC during 24 months (M) of rosuvastatin therapy. All subjects received a clinical follow-up (F/U) visit and a repeat carotid MRI scan at 48 M as planned REACH-F/U. Despite receiving a strong recommendation to continue the statin therapy at 24 M when REACH was completed, only 15 subjects continued taking statins (rosuva.=9, simva.=4 and atorva.=2) in REACH-F/U and 17 discontinued. Lipids and LRNC, both in volume (V) and % (LRNC-V/Wall Vх100%), were compared between the statin-continued and -discontinued groups at 48 M.
Results: There were no significant differences in demographic, clinical characteristics, lipids and plaque changes during 24 M in REACH between the statin-continued and -discontinued groups in REACH-F/U. Not surprisingly, at 48 M, total-Cholesterol (C), LDL-C and triglycerides were significantly lower in subjects who continued statin than those discontinued (163±43 vs. 207±30 mg/dl, p=0.002), (93±36 vs. 131±22 mg/dl, p=0.001) and (85±27 vs. 143±65 mg/dl, p=0.003), while HDL-C levels were similar. LRNC-V and %LRNC decreased significantly from 24 M in the statin-continued group (101±76 mm3 at 24 M vs. 76±65 mm3 at 48 M, p=0.001) and (17.3±11.9% at 24 M vs. 12.6±7.6% at 48 M, p=0.04). By contrast, subjects who discontinued statin showed non-statistically significant increase in LRNC-V and %LRNC (103±93 mm3 at 24 M vs. 112±106 mm3 at 48 M, p=0.4) and (15.4±11.3% at 24 M vs. 16.7±11.4% at 48 M, p=0.07). Furthermore, the changes in LRNC-V and %LRNC from 24 to 48 M were significantly different between the statin-continued and -discontinued groups in REACH-F/U (-25±18 vs. 9±14 mm3, p<0.001) and (-4.6±8.2 vs. 1.3±2.8%, p=0.009).
Conclusion: Continued statin therapy in REACH-F/U resulted in continued decrease in LRNC, which indicates improved plaque stability. These findings provided vascular biological evidence supporting long-term statin therapy.
Author Disclosures: R. Du: None. X. Zhao: None. J. Cai: None. B. Cui: None. P. Ye: None.
- © 2015 by American Heart Association, Inc.