Pravastatin reduces carotid intima-media thickness progression in an asymptomatic hypercholesterolemic Mediterranean population: The Carotid Atherosclerosis Italian Ultrasound Study

Letter by Ntaios et al Regarding Article, "Impact of Statin Therapy on Left Ventricular Function and Carotid Arterial Stiffness in Patients With Hypercholesterolemia"

“…3 The CAIUS study concluded that pravastatin (40 mg) decreases the mean maximum IMT in dyslipidemic patients by 0.0043 mm within 1 year of treatment, compared with an increase of 0.009mm in patients treated with placebo. 4 Similar findings were noticed by Wiegman et al in children with familial hypercholesterolemia, wherein pravastatin decreased IMT by 0.010 mm within 2 years, compared with an increase of 0.005 mm in placebo-controlled children. 5 The effect of pravastatin on IMT was also investigated by McMahon et al in patients with coronary artery disease; they showed a statistically significant difference in mean IMT between active treatment and placebo groups (-0.014 mm vs 0.048 mm, respectively) within 4 years of treatment with pravastatin (40 mg).…”

“…10 A possible explanation for the negative results of the Mizuguchi trial could be the modest duration of follow-up, although this same duration was sufficient to demonstrate a positive effect on IMT in many statin trials. 4,8 The small sample size (n=30) of the study is another possible reason.…”

Stromelysin-1 and Interleukin-6 Gene Promoter Polymorphisms Are Determinants of Asymptomatic Carotid Artery Atherosclerosis

“…Two certified sonographers performed the ultrasound scanning from the anterior oblique, lateral, and posterior oblique views by using standardized and pretested protocols. 27 The calibration of the ultrasound unit was routinely checked with the use of an RMI 414B tissue phantom. The examination was recorded on half-inch videotape (Panasonic 7330 SVHS).…”

Mean Common or Mean Maximum Carotid Intima-Media Thickness as Primary Outcome in Lipid-Modifying Intervention Studies

“…Through a reference check one additional trial was identified 32) . Ultimately, this resulted in 15 CIMT trials for analyses 5, 7-10, 12, 13, 15, 16, 18,19,21,22,30,32) . For each drug used in the CIMT trials, the corresponding event trials were searched, resulting in 15 clinical event trials for lovastatin, pravastatin, fluvastatin, simvastatin, atorvastatin, torcetrapib, rosuvastatin and ezetimibe, as presented in Table 2 [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] .…”

“…Using all trials, the relationship between achieved LDL cholesterol and CIMT progression was modest: one mmol/L increase in achieved LDL was associated with 2.4 m/year [95% CI 3.1, 7.9] increase in common CIMT progression and with a 3.6 m/yr [ 4.8, 12.0] increase in mean maximum CIMT progression. Using placebo-controlled trials, the relationship between the achieved LDL cholesterol and CIMT progression: 1 mmol/L increase in LDL was associated with 6.0 m/year [95% CI 0.9, 13.0] increase in common CIMT progression and with a 6.8 m/year [95% CI 4.9, 18.4] increase in mean maximum CIMT progression. As the 95% CI overlap, the differences in the strength of the relationship of LDL with progression did not differ between the two CIMT measurements.…”