Can Intensive Lipid-Lowering Therapy Improve the Carotid Intima-Media Thickness in Japanese Subjects Under Primary Prevention for Cardiovascular Disease?: The JART and JART Extension Subanalysis

Abstract

Aim: This subanalysis aimed to clarify whether intensive lipid-lowering therapy with statins slows the progression of atherosclerosis in Japanese subjects under treatment for primary prevention of cardiovascular disease. Methods: This was a subanalysis of the Justification for Atherosclerosis Regression Treatment (JART) Study. We compared the efficacy of intensive lipid-lowering therapy and conventional therapy with respect to changes in the mean intima-media thickness (IMT) and serum lipid levels. We also evaluated changes in the mean IMT over 24 months of treatment and assessed the relationship between these changes and reductions in the LDL-C levels using a post-hoc analysis. Results: Intensive lipid-lowering therapy with rosuvastatin was associated with significantly smaller changes in the mean IMT and a greater reduction in the serum lipid levels in comparison to conventional therapy with pravastatin. The average net change in the mean IMT was 0.010 mm (n = 121) at 12 months and −0.004 mm (n = 56) at 24 months. A decrease in LDL-C was found to be associated with a smaller change in the mean IMT (p = 0.0009; Jonckheere-Terpstra trend test). A greater reduction in serum LDL-C was found to be associated with a smaller change in the mean IMT. Similar associations were observed for the serum TC and non-HDL-C levels and LDL-C/HDL-C ratio. There were no notable differences in the incidence of serious adverse events among the LDL-C quartiles. Conclusions: Lowering the LDL-C level with intensive lipid-lowering therapy is associated with reduced changes in the IMT among Japanese subjects at moderate to high risk under treatment for primary prevention. Subjects suitable for primary prevention may receive cardiovascular benefits from intensive lipid-lowering therapy, in association with significantly slower IMT progression than that observed with conventional therapy. J Atheroscler Thromb, 2014; 21:739-754.

Different Impacts of Cardiovascular Risk Factors on Arterial Stiffness versus Arterial Wall Thickness in Japanese Patients with Type 2 Diabetes Mellitus

“…On the other hand, glycemic control might be beneficial for the cholesterol levels and lower HDL cholesterol levels were associated with greater wall thickness rather than greater arterial stiffness. These findings were also suggested by previous reports 19,20,[29][30][31][32][33] . As accumulating evidence shows, LDL is a primary pro-atherogenic lipoprotein and its excess in blood leads to atheroma formation in the arterial wall 34) .…”

Intensive Lipid-Lowering Therapy Ameliorates Asymptomatic Intracranial Atherosclerosis

“…It indicated that persistent intensive statin therapy had a significant efficacy for the regression of intracranial stenotic vessels. These findings in the development of the degree of asymptomatic stenosis were in accordance with relevant reports using ultrasound [19-23].…”

“…Atherosclerosis is a progressive disease, moreover, it has been confirmed in several studies that statins have a stabilizing or even reverse effect on aortic atherosclerosis [17]. Statin therapy was also associated with slower rates of progression in plaque burden and intima-media thickness among patients with asymptomatic carotid atherosclerosis [18, 19]. Extensive analysis revealed an association between the preventive effects of statins with low-density lipoprotein cholesterol (LDL-C) reduction [16].…”

Carotid Intima-Media Thickness for Atherosclerosis

“…Several clinical trials using lipid-lowering drugs have used the carotid IMT as a clinical endpoint 12-14, 90,91) . regression of the carotid IMT is associated with a reduced incidence of events 21) .…”