Review Article

Impact of Medical Therapy on Atheroma Volume Measured by Different Cardiovascular Imaging Modalities

Table 2

Summary of trials highlighting the pleiotropic effects of medications and treatment modalities used in the treatment of dyslipidemias.

Study MedicationImaging modalityFollow-up (months)OutcomeResult -value

SCAT [18]394Simvastatin versus PlaceboQCA47.8 mean diameter (mm)−0.07 versus −0.14.004
minimum diameter (mm)−0.09 versus −0.16.001
% diameter stenosis (%)+1.67 versus +3.83.0003

Brown et. al. [35]160Simvastatin + niacin + antioxidants versus placeboQCA36% diameter stenosis+0.7 ± 3.2 versus
+3.9 ± 5.2; P < .005
P = .02 for the difference b/w Simvastatin + Niacin + antioxidants and Simvastatin+Niacin alone
Simvastatin + niacin versus placebo−0.4 ± 2.8 versus
+3.9 ± 5.2; P < .001

CLAS [34]162Colestipol/niacinQCA24% diameter stenosis (%)0.3 ± 5.9 versus 2.7 ± 5.8.02
MLD (mm)−0.01 ± 0.22 versus −0.09 ± 0.26.04

REVERSAL [14]65480 mg atorvastatin versus 40 mg pravastatinIVUS18 atheroma volume (%)−0.4 versus +2.7.02

METEOR [42]984Rosuvastatin versus placeboB-ultrasound24 CIMT (mm/yr)−0.0014 versus +0.0131P < .001

ESTABLISH [36] 70Atorvastatin versus placeboIVUS6 plaque volume (%)−13.1 ± 12.8 versus +8.7 ± 14.9<.0001

ENHANCE [40]720Simvastatin versus Simvastatin + ezetimibeB-ultrasound24 CIMT (mm)0.0058 ± 0.0037 versus 0.0111 ± 0.0038.29

SANDS [41]499Standard Rx : LDL <100 with statin aloneB-ultrasound36 CIMT (mm)+0.039P < .0001 between standard Rx. and aggressive Rx.
Aggressive Rx : LDL <70 with Statin alone versus Statin + ezetimibe−0.025 versus −0.012; P = .999

LACMART [37]18LDL-apheresis + HMG-CoAIVUS12 MLD (mm)+0.12 versus −0.08.008
reductase I versus HMG-CoA reductase I plaque area (mm2)−0.69 versus +0.88.017

ASTEROID [28]349RosuvastatinIVUS24Mean PAV (%)−0.98 ± 3.15<.001
Median total atheroma volume (%)−6.8<.001

Schartl et al. [39]131Atorvastatin versusIVUS12Plaque volume (mm3)1.2 ± 30.4 versus 9.6 ± 28.1.191
Usual carePlaque echogenicity index (%)42.2 versus 10.1.021

DAIS [44]731Fenofibrate versus placeboQCA36 MLD (mm)−0.06 ± 0.01 versus −0.10 ± 0.016.029

FIELD [45]170Fenofibrate versus placeboCIMT60 CIMT (mm/yr)0.140 versus 0.098.722

Zhu et al. [46]594Fenofibrate versus placeboCIMT24CIMT/D %12.98 ± 2.62 versus 12.12  ± 2.26P< .05

SENDCAP [47]164Bezafibrate versus placeboCIMT36 CIMT (mm)0.06 ± 0.38 versus 0.02 ± 0.41P = .5

ACTIVATE [48]534ACAT inhibitor (pactimibe) versus placeboIVUS18 PAV (%)0.69 versus 0.59.77
Net atheroma volume (mm3)−1.3 versus −5.6.03

A-PLUS [49, 50]525ACAT inhibitor (avasimibe) versus PlaceboIVUS24 PAV (%)+0.4 versus +0.83NS

Nissen et al. [52]123Recombinant Apo A-1 Milano/phospholipid complex (ETC-216) IVUS5 wks PAV (%)−1.06 ± 3.17.02 (active)
+0.14 ± 3.09.97 (placebo)
atheroma volume (mm3)−14.1<.001

Surrey et al. [56]330Lipoprotein-associated phospholipase A2 inhibitor (Darapladib) IVUS12 Atheroma volume (mm3)−4.9 ± 32.7 versus −5.0 ± 28.0.95
IVUS-RF Necrotic core volume (mm3)−0.5 mm3; P = .71 versus +4.5; P = .009.012

Baseline versus Followup