pitavastatin and Carotid-Artery-Diseases

This study is a prospective multicenter study designed to investigate the effects of lipid-lowering therapy with pitavastatin on atherosclerotic plaque in patients with coronary heart disease, and to determine which factor is more closely associated with plaque regression. Participants (n = 63) were treated with pitavastatin for 12 months, and the carotid intima-media thickness (IMT) was measured by ultrasound before and after treatment. Mean IMT slightly but significantly decreased (from 0.99 ± 0.33 to 0.94 ± 0.28 mm for overall, P = 0.01) regardless of the presence of pretreatment with other statins. There were no significant relations with hs-CRP, malondialdehyde-LDL, LDL cholesterol, and smaller LDL cholesterol levels despite their decrease by pitavastatin. Decreases in mean IMT were observed significantly more frequently in subjects with high on-treatment HDL cholesterol levels than with low HDL cholesterol levels (P = 0.017). The change in mean IMT tended to be inversely correlated with increments in HDL cholesterol and apolipoprotein A-I. The IMT regression was more often observed in the absence of diabetes and metabolic syndrome. In conclusion, we demonstrated that treatment with pitavastatin attenuated atherosclerotic plaque. This effect was associated with the level of HDL cholesterol, and was stronger in the absence of diabetes and metabolic syndrome in our ischemic heart disease patients.

Topics: Aged; Biomarkers; Carotid Artery Diseases; Carotid Artery, Common; Carotid Intima-Media Thickness; Cholesterol, HDL; Comorbidity; Coronary Disease; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Japan; Male; Middle Aged; Plaque, Atherosclerotic; Predictive Value of Tests; Prospective Studies; Quinolines; Risk Factors; Time Factors; Treatment Outcome

3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have multiple pleiotropic effects, such as anti-inflammatory and vascular endothelium protection, that are independent of their low-density-lipoprotein (LDL) cholesterol lowering effects. However, whether different statins exert diverse effects on inflammation, insulin resistance, and the progression of carotid atherosclerosis [as indicated by the intima-media thickness (CIMT)] in patients with dyslipidemia remains unclear.. A total of 146 patients with hypercholesterolemia without known cardiovascular disease were randomly assigned to receive 5 mg/day of atorvastatin (n=73) or 1 mg/day of pitavastatin (n=73).. At baseline, age, gender, blood pressure, lipid profiles, and the serum monocyte chemoattractant protein (MCP)-1, homeostasis model assessment of insulin resistance (HOMA-IR) and CIMT values were comparable between the groups. After 12 months of treatment, atorvastatin and pitavastatin equally reduced the LDL cholesterol levels; however, atorvastatin increased the HOMA-IR by ＋26% and pitavastatin decreased this parameter by －13% (p＜0.001). The MCP-1 values were reduced by －28% in the patients treated with pitavastatin and only －11% in those treated with atorvastatin (p=0.016). A greater percent decrease in the mean CIMT from baseline was observed in the patients treated with pitavastatin than in those treated with atorvastatin (－4.9% vs. －0.5%, p=0.020).. These data indicate that, while these agents significantly and equally reduce the LDL cholesterol levels, atorvastatin and pitavastatin have different effects on inflammation, insulin resistance, and the progression of carotid atherosclerosis in patients with dyslipidemia.

Topics: Aged; Atorvastatin; Carotid Artery Diseases; Carotid Intima-Media Thickness; Dyslipidemias; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypercholesterolemia; Inflammation; Insulin Resistance; Male; Prognosis; Prospective Studies; Quinolines

Atherosclerosis often advances before symptoms appear. It remains uncertain whether intensive cholesterol-lowering therapy with statin is beneficial when compared with moderate cholesterol-lowering therapy in patients with subclinical carotid atherosclerosis.. The PEACE study was a prospective, randomized, open-labeled, blinded end points, two-arm parallel treatment group comparison study conducted at 15 centers in Japan. A total of 303 patients with carotid intima-media thickness (CIMT) thickening (>1.1 mm) whose low-density lipoprotein cholesterol (LDL-C) level was more than 100 mg/dl were enrolled, in which 223 patients completed the 12 months' follow-up study. Patients were randomly assigned to receive either moderate (target LDL-C; 100 mg/dl) or intensive (target LDL-C; 80 mg/dl) cholesterol-lowering therapy with pitavastatin. The primary end point was the change in mean far wall common CIMT.. LDL-C level declined to 89.4 ± 20 mg/dl in the intensive group, while it declined to 95.1 ± 22.5 mg/dl in the moderate group at 12 months' follow-up (p < 0.05 between the groups). The change in mean CIMT was -0.024 (95% confidence interval -0.046 to -0.0014) mm/year (p < 0.05 vs. baseline) in the intensive group, and -0.0078 (95% confidence interval -0.028 to 0.012) mm/year (p = 0.4406 vs. baseline) in the moderate group. However, there was no significant difference in the change in mean far wall common CIMT between the groups (p = 0.29).. Intensive cholesterol-lowering therapy did not show superior effects on the progression of CIMT to moderate cholesterol-lowering therapy, whereas only intensive cholesterol-lowering therapy regressed the carotid atherosclerosis over one year.

Topics: Aged; Asymptomatic Diseases; Biomarkers; Carotid Artery Diseases; Carotid Artery, Common; Carotid Intima-Media Thickness; Cholesterol, HDL; Cholesterol, LDL; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Japan; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Quinolines; Time Factors; Treatment Outcome; Triglycerides