Effect of Lipid-Lowering Treatment on Progression of Atherosclerotic Lesions—a Duplex Ultrasonographic Investigation

Abstract

The Prevenzione Aterosclerosi Studio Torino (P.A.S.T.) was a prospective, randomized trial testing the effect on carotid and femoral atherosclerotic lesions of lipid-lowering therapy, as assessed by duplex scanning (DS) technique, in 85 patients (12 women, 73 men), forty-five to fifty-five years old, with ischemic heart disease (IHD), and randomly assigned to a hypolipidemic diet or diet + 250 mg acipimox (a nicotinic acid compound) two to three times/day. Forty-one patients, without inclusion criteria, were compared with the randomized groups as a reference population. All three groups were submitted to DS and to hematic monitoring of lipid levels at the beginning and at the end of the study. During three years of treatment, there was a significant reduction (-6.5%) in total plasma cholesterol in the diet + drug group (P = 0.04) and a simultaneous elevation of high-density lipoprotein cholesterol, significant in the treatment groups (respectively, +15% P = 0.02 in the diet and +16% P = 0.016 in the diet + drug group). Every group showed a trend toward the increasing number of lesions in all explored areas and toward the progression in size of the already existing ones. Whereas in the initial DS the prevalence of lesions was significantly lower in the nonrandomized group in every site, at the end of the study the total number of lesions did not differ among groups, and there was a significant increase of plaques in carotid area in the nonrandomized group in comparison with the treatment groups. The final number of stable plaques was greater in the treatment groups as compared with the nonrandomized group (P = 0.01 diet vs nonrandomized, P = 0.03 diet + drug vs nonrandomized). In conclusion, lipid-lowering treatment, with diet and with diet + drug, was useful in slowing the natural progression of atherosclerosis; particularly, it reduced the development of new lesions in the carotid and femoral arteries and increased the stability of the already existing ones. In these patients, diet was equivalent to diet + drug in regard to progression of lesions. The most favorable results in the treatment groups seem to correlate with high-density lipoprotein cholesterol, significantly increased in comparison with the nonrandomized group.

Assessment of the Role of Niacin in Managing Cardiovascular Disease Outcomes

“…The 9 studies published from 1990 to 2011 contributed little further predictive value to the cumulative estimates. 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 The findings then moved toward the null since 2011, owing to the Atherothrombosis Intervention in Metabolic Syndrome With Low HDL/High Triglycerides trial (AIM-HIGH, 2011) 3 and Heart Protection Study 2–Treatment of HDL to Reduce the Incidence of Vascular Events (HSP2-THRIVE, 2014) 4 trials (eFigure 2 in the Supplement ).…”

“…Overall, 14 studies provided data with which to analyze the association of the change in HDL-C levels with cardiovascular outcomes. 3 , 4 , 33 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 Univariate and multivariate metaregression analyses, adjusted for change in LDL-C measurements and sample size, are presented in Table 2 . Change in HDL-C levels was not associated with the log risk ratio for primary cardiovascular outcomes.…”

Cholesterol Lowering Modulates T Cell Function In Vivo and In Vitro

“…Dietary and life style intervention has been known to slow the progression or promote modest regression of atherosclerotic lesions in human as demonstrated in several randomized clinical trials [27]–[29], hence such intervention becomes the first step in the management of patients with atherosclerotic cardiovascular diseases. However these clinical trials seldom address the potential mechanisms underlying the observed favorable clinical end-ponts.…”

Pravastatin Therapy and the Risk of Stroke

“…26 It has been reported that total and LDL cholesterol levels may be associated with thickening of the intima-media layer of the carotid artery, as determined by B-mode ultrasonography of the carotid artery, 27,28 and indeed, lipid-lowering therapy has been shown to reduce the progression of carotid intimamedia thickening. 22,[29][30][31][32][33][34][35] In a substudy of the LIPID study, pravastatin reduced the development of carotid-wall thickening over a four-year follow-up period. 35 The effect of treatment was similar among subgroups of patients defined according to cholesterol level at base line.…”