Determinants of Arterial Wall Remodeling During Lipid-Lowering Therapy

Schoenhagen, Paul; Tuzcu, E. Murat; Apperson-Hansen, Carolyn; Wang, Chaohui; Wolski, Kathy; Lin, Songhua; Sipahi, İlke; Nicholls, Stephen J.; Magyar, William A.; Loyd, Aaron; Churchill, Tammy; Crowe, Tim; Nissen, Steven E.

doi:10.1161/circulationaha.105.585703

Cited by 141 publications

(38 citation statements)

References 36 publications

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“…Our observations extend those of Nicholls et al [3] and differ from earlier, smaller studies that failed to demonstrate a relationship between HbA 1c and remodelling [11,20]. In the Reversal of atherosclerosis with aggressive lipid lowering therapy (REVERSAL) trial, a similarly sized trial to our own, diabetes status was not a predictor of coronary artery remodelling, but data on FBG and HbA 1c were lacking [10].…”

Section: Discussionsupporting

confidence: 51%

“…To date, most imaging studies relating glycaemic status to CAD have lacked information on serial examinations [2,11,12,19,20], diabetes treatment [3,5,[10][11][12]19], FBG [5,10,11,19,20] or a non-diabetic control group [11,20]. Our investigation provides more detailed information than these previous reports, helps clarify some of the outstanding questions on this subject and complements the results from a recent pooled analysis of five randomised clinical trials [3].…”

Section: Discussionmentioning

confidence: 69%

“…We observed that the usual interrelationships between plaque and lumen areas [10] were disturbed in diabetes and that vascular remodelling was thus not active as a protective mechanism across as wide a range of lesion severity as in non-diabetic patients. This failure of vascular remodelling associated with diabetes may be caused by increased extracellular fibrosis [22].…”

Section: Discussionmentioning

confidence: 76%

“…Intravascular ultrasound (IVUS) provides a quantitative tomographic assessment of atheroma burden and its change over time, as well as of atheroma progression or regression; it is therefore a much more sensitive tool for CAD evaluation than angiography [8,9]. IVUS also characterises coronary artery remodelling [10]. However, IVUS studies of glycaemic status and CAD have been limited by small sample size and lack of serial imaging [2,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Glycaemic status influences the nature and severity of coronary artery disease

et al. 2010

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Aims/hypothesis We sought to understand the relationships between glycaemic status and both severity and progression of coronary artery disease (CAD), the leading cause of death in diabetes. Methods Baseline fasting blood glucose (FBG) and HbA 1c (%) were measured in 426 patients with known or suspected stable CAD, who underwent coronary artery intravascular ultrasound (IVUS) at baseline and after a mean follow-up period of 664 days (range 257 to 961). The patients were categorised as normoglycaemic (n=226, 53%), or as having impaired fasting glucose (n=118, 28%) or diabetes (n=82, 19%). Results The maximum percentage coronary atheroma area at baseline was greater in diabetic patients (73.33±8.86%) than in those with normoglycaemia (69.08±10.43%; p=0.001) and impaired fasting glucose (69.32±9.59%; p=0.0031). In averaged IVUS measurements of the 30-mm target segment (n=332 participants), change in percentage atheroma area during follow-up was also greater in the diabetes (1.86± 3.90%) than in other groups (0.28±3.32% and 0.56±2.96%, p=0.0047 global). FBG correlated with maximum percentage atheroma area at baseline (r=0.17; p=0.0003). HbA 1c also correlated with maximum percentage atheroma area at baseline (r=0.26; p=0.0001) and with change in maximum plaque area (r=0.16; p=0.016). A similar pattern of results occurred with plaque volume. The relationships between diabetes or HbA 1c and both IVUS measurements of plaque burden and remodelling persisted after adjustment. Conclusions/interpretation Fasting blood glucose, HbA 1c and the presence of diabetes are associated with the severity and progression of coronary atherosclerosis. These observations support the hypothesis that better glycaemic control may favourably influence CAD in patients with abnormal glucose tolerance or diabetes.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

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Glycaemic status influences the nature and severity of coronary artery disease

et al. 2010

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“…Serial IVUS studies confirmed that remodeling is an important process during disease progression/regression. These studies demonstrate that plaque-stabilizing therapy is associated with constrictive remodeling 124 .…”

Section: Correlation Between Ivus and Cimtmentioning

confidence: 69%

Métodos por imagem da aterosclerose em estudos de progressão/regressão: marcador substituto ou janela direta para o processo patológico da aterosclerose?

Schoenhagen¹,

Tuzcu²

2008

Arq. Bras. Cardiol.

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SummaryCAD remains a major global cause of morbidity and mortality. Comprehensive drug development programs of novel pharmacological treatment strategies frequently utilize traditional mortality/morbidity endpoints studies and additional surrogate endpoints trials. This parallel approach allows an assessment of efficacy several years in advance of the availability of data from clinical endpoint trials. Several atherosclerosis imaging markers have been introduced into these drug-development strategies, including angiography, carotid ultrasound, IVUS, MRI, and CT. This review will discuss the current status of atherosclerosis imaging as an endpoint in progression/regression trials, with an emphasis on evidence-based data. In addition to a discussion of the results of individual imaging modalities, the emerging data comparing different modalities and approaches are presented.

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Intracranial atherosclerotic disease: An update

Qureshi

Feldmann

Gomez³

et al. 2009

Annals of Neurology

100

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The consensus conference on intracranial atherosclerosis provides a comprehensive review of the existing literature relevant to the epidemiology, diagnosis, prevention, and treatment of intracranial atherosclerosis, and identifies principles of management and research priorities. Patients who have suffered a stroke or transient ischemic attack attributed to stenosis (50-99%) of a major intracranial artery face a 12 to 14% risk for subsequent stroke during the 2-year period after the initial ischemic event, despite treatment with antithrombotic medications. The annual risk for subsequent stroke may exceed 20% in high-risk groups. In patients with intracranial atherosclerotic disease, short-term and long-term anticoagulation is not superior to antiplatelet treatment. Overall, the subgroup analyses from randomized trials provide evidence about benefit of aggressive atherogenic risk factor management. Intracranial angioplasty with or without stent placement has evolved as a therapeutic option for patients with symptomatic intracranial atherosclerotic disease, particularly those with high-grade stenosis with recurrent ischemic symptoms, medication failure, or both. A multicenter randomized trial is currently under way to compare stent placement with intense medical management for patients with high-grade symptomatic intracranial atherosclerotic disease.

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Determinants of Arterial Wall Remodeling During Lipid-Lowering Therapy

Abstract: Constrictive remodeling of the arterial wall was observed during plaque-stabilizing therapy with statin medications and appears related to their antiinflammatory effects.

Cited by 141 publications

References 36 publications

Glycaemic status influences the nature and severity of coronary artery disease

Glycaemic status influences the nature and severity of coronary artery disease

Métodos por imagem da aterosclerose em estudos de progressão/regressão: marcador substituto ou janela direta para o processo patológico da aterosclerose?

Intracranial atherosclerotic disease: An update

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