Prolonged combination lipid therapy is associated with reduced carotid intima-media thickness: A case-control study of the 20-year Familial Atherosclerosis Treatment - Observational Study (FATS-OS)

Abstract

Background Studies have documented the short-term vascular benefits of combination lipid therapy. Objective Our objective was to evaluate the long-term effects of combination lipid therapy on carotid intima-media thickness (CIMT) in patients with coronary artery disease (CAD). Methods We performed a case-control study in patients who had finished the Familial Atherosclerosis Treatment Study (FATS) and returned to usual care with statin therapy alone or had elected to participate in the 20-year FATS-Observational Study (FATS-OS) and received combination therapy with lovastatin (40 mg/day), niacin (2–3 gm/day), and colestipol (20 gm/day) for 11 years, then continued with simvastatin (10–80 mg/day) or lovastatin (40–80 mg/day) plus niacin (2–4 gm/day). After 17.8 ± 0.8 years with combination therapy and 19.0 ± 0.8 years with usual care, cholesterol levels and CIMT were collected in 43 FATS-OS patients and 26 usual care patients. Results Combination therapy group had a greater decrease in total cholesterol (-42 ± 14% vs. −31 ± 17%, p=0.008) and low density lipoprotein cholesterol (LDL-C) (-57 ± 13% vs. −38 ± 25%, p<0.001) and greater increase in high density lipoprotein cholesterol (HDL-C) (38 ± 43% vs. 15 ± 23%, p=0.02) as compared to usual care. CIMT (0.902 ± 0.164 vs. 1.056 ± 0.169 mm, p < 0.001) on intensive therapy was significantly less compared to usual care. Multivariate regression analysis (coefficient, 95% CI) showed that combination therapy (-0.13, −0.21 – −0.04, p=0.003) and on-therapy LDL-C (0.15, 0.02 – 0.28, p=0.03) were significant independent predictors of CIMT. Conclusions Prolonged combination lipid therapy is associated with greater improvements in LDL-C and HDL-C levels and less atherosclerotic burden as compared to statin therapy alone.

Evaluation of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area of Romania

“…After the administration of the lipid-lowering agents for 24 months, it was found a decreased of the TC, LDL-C levels and elevated HDL-C levels, but without reaching the goals according to the European Guide of Dyslipidaemias 2019, the most effective treatment being the double association between high-dose statin and feno brate. At the same time, in a case-control study (43 patients with FH and 26 controls) with a 20 years follow up of lipid-lowering therapy (statin with niacin), patients exhibited improved lipid pro le compared to patients treated with statin in monotherapy (30). The same results following the administration of lipid-lowering drugs were also revealed by Brunham et al, in a longitudinal observational study that enrolled 339 subjects based on clinical diagnosis of FH (≥ 50% LDL-C reduction in 34.5% FH patients) (31).…”

Familial Hypercholesterolemia: New Horizons for Diagnosis and Effective Management

“…Furthermore, a study in 40 FH patients has also showed that their Carotid Intima-Medial Thickness (CIMT) is significantly higher (0.7–1.83 mm) compared to controls (0.48–0.73 mm) (Khan et al, 2011 ). However, the significance of monitoring CIMT is not established yet, since CIMT regression does not appear to directly correlate with CVD outcomes, and coronary artery calcium might be of greater prognostic value (Costanzo et al, 2010 ; Phan et al, 2014 ).…”

Efficacy and safety of Chinese herbal for carotid atherosclerosis

“…However, different types of statin drugs have been derived due to the differences in chemical structure and drug properties. Clinical studies have confirmed that statins can reduce carotid IMT and prevent the formation of new arterial plaques by reducing the LDL content in the blood [14–16] . High-dose statins can significantly reduce the content of macrophages in atherosclerotic lesions, inhibit plaques inflammatory response, stabilize plaques, but cannot eliminate the formed plaques [17,18] .…”

“…Clinical studies have confirmed that statins can reduce carotid IMT and prevent the formation of new arterial plaques by reducing the LDL content in the blood. [14][15][16] High-dose statins can significantly reduce the content of macrophages in atherosclerotic lesions, inhibit plaques inflammatory response, stabilize plaques, but cannot eliminate the formed plaques. [17,18] Long-term use of statins can control the growth rate of carotid plaque and delay the occurrence of cardiovascular and microembolization events.…”