Rapid Stabilization of Vulnerable Carotid Plaque Within 1 Month of Pitavastatin Treatment in Patients With Acute Coronary Syndrome

Nakamura, Takamitsu; Obata, Jun–ei; Kitta, Yoshinobu; Takano, Hajime; Kobayashi, Tsuyoshi; Fujioka, Daisuke; Saitō, Yukio; Kodama, Yasushi; Kawabata, Ken‐ichi; Mende, Akira; Yano, Toshiaki; Hirano, Minoru; Sano, Keita; Nakamura, Kazuto; Kugiyama, Kiyotaka

doi:10.1097/fjc.0b013e318165dcad

Cited by 72 publications

(54 citation statements)

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“…Recent clinical studies of pitavastatin in patients with ACS have reported a size reduction of coronary plaques 14 and early stabilization of carotid arterial plaques within 1 month. 25 The differences between pitavastatin and atorvastatin treatment in IVUS in the early stage might occur for the following 3 reasons. First, the main action of statins is enhancement of LDL receptor expression in the liver to decrease the blood LDL-C level.…”

Section: Discussionmentioning

confidence: 99%

Early Effect of Lipid-Lowering Therapy With Pitavastatin on Regression of Coronary Atherosclerotic Plaque Comparison With Atorvastatin

Toi

Tanaka

Yoneda

et al. 2009

Circ J

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arge-scale clinical studies have recently shown an inhibitory effect on cardiovascular events of lipidlowering therapy with HMG-CoA reductase inhibitors (statins), indicating the usefulness of this therapy. [1][2][3][4][5][6][7][8] The benefit is particularly marked in patients with coronary heart disease (CHD), and the guidelines of the American National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III positively state the utility of lipid-lowering therapy in reducing low-density lipoprotein (LDL)-cholesterol (C) to below 70 mg/dl in patients with coronary artery disease. 9 In Japan, the guidelines for prevention of arteriosclerotic diseases specify a target value of LDL-C of less than 100 mg/dl for control of CHD patients in category C. 10 Evaluation of coronary arterial plaques by imaging diagnosis has progressed markedly in recent years. In the REVERSAL study, intravascular ultrasonography (IVUS) was used to compare the effect of lipid-lowering therapy between CHD patients treated with standard and active regimens, with the latter found to inhibit expansion of coronary plaques. 11 Size reduction of coronary plaques on IVUS by statin treatment in patients with acute coronary syndrome (ACS) has also been reported in Japan (the ESTABLISH study). 12 Subsequent multicenter studies such as the JAPAN-ACS study have verified the ESTABLISH results through investigation of strong statin-induced volume reduction of coronary plaques. [13][14][15] However, these studies have all evaluated quantitative changes of the plaques, and there have been fewer qualitative evaluations. 16 Spectral analysis of IVUS radiofrequency (RF) data can provide detailed quantitative and qualitative information on coronary plaque composition in vivo. [17][18][19][20][21] Nasu et al found that in vivo characterization of coronary plaques by 'virtual histology (VH)' correlated favorably with the results of in vitro histopathological examination of tissue samples obtained by directional coronary atherectomy. 22 In this study, we used VH-IVUS to evaluate short-term quantitative and qualitative changes in non-culprit lesions in a comparison of pitavastatin, a new strong statin, with atorvastatin after administration in the early stage (2-3 weeks) after onset of ACS. The follow-up period of 2-3 weeks was chosen to evaluate the inhibition of short-term events within 1 month by early statin administration after ACS onset, and to examine if the statin effect starts to appear in this period. Methods Study Design and Patient PopulationThe study was performed as a prospective, randomized, single-center trial to assess the effect of 2-to 3-weeks of (Received November 5, 2008 Patients with acute coronary syndrome who underwent emergency percutaneous coronary intervention (PCI) were randomly assigned to receive pitavastatin (n=80; 2 mg/day) or atorvastatin (n=80; 10 mg/day) immediately after PCI. All patients underwent a blood lipid test and VH-IVUS evaluation of non-PCI lesions at admission and after 2-3 weeks of statin administration. A...

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Section: Discussionmentioning

confidence: 99%

Early Effect of Lipid-Lowering Therapy With Pitavastatin on Regression of Coronary Atherosclerotic Plaque Comparison With Atorvastatin

Toi

Tanaka

Yoneda

et al. 2009

Circ J

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“…Nakamura et al [10] reported that plaque stabilization of unstable carotid plaque significantly occurred by pitavastatin therapy within 1 month on ultrasonography. Yoshimura et al [8] reported that unstable plaque on time-of-flight MR angiography was associated with more ipsilateral ischemic lesions on DWI after CAS.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the antihyperlipidemic effects, 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors (statins) have the pleiotropic effects, including plaque stabilization, improvement of endothelial function, reduction in vascular inflammation, reduction of platelet aggregation, and thrombus deposition [9][10][11]. Statins can reduce periprocedural complications when administered before coronary intervention [12].…”

Section: Introductionmentioning

confidence: 99%

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

Takayama

Taki

Toma

et al. 2013

Cardiovasc Intervent Radiol

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Purpose Periprocedural ischemic stroke is one problem associated with carotid artery stenting (CAS). This study was designed to assess whether preoperative statin therapy reduces the risk of periprocedural ischemic complications with CAS. Methods In this prospective study at 11 centers, patients with carotid artery stenosis (symptomatic C50 %, asymptomatic C80 %) and a high risk of carotid endarterectomy but without previous statin treatments were divided into two groups by low-density lipoprotein cholesterol (LDL-C) levels. With LDL-C C120 mg/dl, the pitavastatin-treated (PS) group received pitavastatin at 4 mg/day. With LDL-C \120 mg/dl, the non-PS group received no statin therapy. After 4 weeks, both groups underwent CAS. Frequencies of new ipsilateral ischemic lesions on diffusion-weighted imaging within 72 h after CAS and cerebrovascular events (transient ischemic attack, stroke, or death) within 30 days were assessed. Results Among the 80 patients enrolled, 61 patients (PS group, n = 31; non-PS group, n = 30) fulfilled the inclusion criteria. New ipsilateral ischemic lesions were identified in 8 of 31 patients (25.8 %) in the PS group and 16 of 30 patients (53.3 %) in the non-PS group (P = 0.028). Cerebrovascular events occurred in 0 patients in the PS group and in 3 of 30 patients (10.0 %) in the non-PS group (P = 0.071). Multivariate analyses demonstrated the pitavastatin treatment (b = 0.74, 95 % confidence interval 0.070-1.48, P = 0.042) to be an independent factor for decreasing post-CAS ischemic lesions.This study was conducted on behalf of the EPOCH-CAS Investigators. The members of EPOCH-CAS Investigators are given in Appendix. 123Cardiovasc Intervent Radiol (2014) 37:1436-1443 DOI 10.1007 Conclusion Pretreatment with pitavastatin significantly reduced the frequency of periprocedural ischemic complications with CAS.

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“…Several studies using coronary artery CT angiography have directly demonstrated that statins reduce non-calcified plaque [86] [87]. Furthermore, atherosclerotic plaques can be stabilized within one month of initiating statin therapy by reducing the plaque's lipid content and inflammatory constituents [88]. They also increase the thickness of the lesions fibrous cap, increasing its stabilization [89].…”

Section: Medicationsmentioning

confidence: 99%

The Application of the LDL Principle

Schade¹,

Cavanaugh²,

Ramo³

et al. 2016

WJCD

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The LDL Principle has recently been invoked to describe the observation that lowering the LDL cholesterol (by whatever means) results in a lowering of atherosclerotic cardiovascular events. The scientific basis of the LDL Principle dates back to the discovery that the LDL receptor is the prime determinant of the circulating LDL-c concentration. Since that time, major advances have been made at both the basic and clinical science level in our understanding of the pathogenesis and reversal of atherosclerosis. The incorporation of atherogenic lipoproteins plus inflammatory mediators into plaque formation permits the targeted intervention into preventing plaque rupture. In addition, genetic studies identifying individuals with unique phenotypes of either abnormally high or low LDL-c concentrations have provided insight into possible therapeutic modalities that have recently provided the physician with the tools necessary to apply the LDL Principle to achieve reversal of atherosclerosis. The epidemic of atherosclerotic cardiovascular disease has resulted in numerous randomized controlled intervention trials in an attempt to identify approaches to reduce ASCD morbidity and mortality. Recently published data indicate that circulating LDL-c levels of 50 mg/dl or less are not only physiologic at birth but also effective in greatly reducing cardiovascular disease. In addition, the recent availability of two PCSK9 inhibitors provides the primary care physician with the possibility of achieving this low level of LDL-c even in statin intolerant patients. The widespread availability of the coronary artery calcium scan plus the inclusion of traditional cardiovascular risk factors in risk assessment has enabled the physician to readily identify asymptomatic individuals at high risk for cardiovascular events. Aggressively applying the LDL Principle to these individuals has the potential of greatly reducing cardiovascular mortality. This review will document the scientific basis for this principle and provide the arguments in favor of its aggressive application.

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Rapid Stabilization of Vulnerable Carotid Plaque Within 1 Month of Pitavastatin Treatment in Patients With Acute Coronary Syndrome

Cited by 72 publications

References 28 publications

Early Effect of Lipid-Lowering Therapy With Pitavastatin on Regression of Coronary Atherosclerotic Plaque Comparison With Atorvastatin

Early Effect of Lipid-Lowering Therapy With Pitavastatin on Regression of Coronary Atherosclerotic Plaque Comparison With Atorvastatin

Effect of Pitavastatin on Preventing Ischemic Complications with Carotid Artery Stenting: A Multicenter Prospective Study—EPOCH-CAS Study

The Application of the LDL Principle

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