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Intravascular Ultrasound Depicts Coronary Artery Plaque Regression With Simvastatin: Presented at AHA

By Ed Susman

ORLANDO, FL -- November 12, 2003 -- Researchers armed with intravascular ultrasound said they have shown that year-long treatment with the lipid-lowering drug simvastatin results in regression of coronary artery plaques.

Lisette Jensen, MD, from the department of cardiology, Odense University Hospital, Odense, Denmark, used three-dimensional intravascular ultrasound to assess the effects of treatment on 40 men with ischemic heart disease.

"Lipid-lowering therapy with simvastatin for 12 months is associated with a significant plaque regression in coronary arteries measured as reduction in plaque and vessel volumes without any concomitant change in lumen volume," Dr. Jensen said here in her poster presentation at the American Heart Association's Scientific Sessions 2003.

She said that while the plaque regression -- about 6.3% from baseline -- reached statistical significance at the P < .001 level, the angiographic results did not reveal any changes.

Dr. Jensen said that angiographic studies do not record remodeling in the cell wall but just reflect lumen diameter. The use of three-dimensional intravascular ultrasound can detect these changes, she said.

In the study, 44 men were recruited to participate, but four were either lost to follow-up or did not meet inclusion criteria. The remaining 40 men first underwent intravascular ultrasound procedures with a device from the CardioVascular Imaging System, Inc., San Jose, California, United States, and an electrocardiogram-triggered pullback unit created by Tom Tec, Munich, Germany.

The men underwent the studies at baseline, after a three-month dietary regulation period, and after 12 months on simvastatin. The men were an average age of 57; about 22% had hypertension; 22% had a previous myocardial infarction; 82% had a previous percutaneous coronary intervention; and 42% were smokers. Their average body mass index was 27.4. Dr. Jensen said the dietary period produced no significant changes in plaque regression or in cholesterol-lowering.

The treatment with simvastatin, however, considerably lowered cholesterol. Total cholesterol was reduced an average of 31%, and low-density lipoprotein (LDL) cholesterol was reduced 42.6%. Both reductions were statistically significant at the P < .001 level, she said.

"Angiography of coronary arteries reflects only changes in luminal directions," Dr. Jensen said. "With three-dimensional intravascular ultrasound, cross-sectional and longitudinal images of both lumen and the vessel wall can be obtained. From this, the volume of plaque, lumen and vessel can be calculated."

In addition to reduction in plaques, she said there was also a significant reduction in vessel volume after simvastatin therapy (P = .012) and a non-significant 0.3% increase in lumen volume seen with the imaging devices.


[Study title: Plaque Regression in Coronary Arteries After 12 Months Treatment With Simvastatin. A Three-Dimensional Intravascular Ultrasound Study. Abstract 2118]

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