Intima-media thickness after pravastatin stabilizes also in patients with moderate to no reduction in LDL-cholesterol levels: the carotid atherosclerosis Italian ultrasound study

The Carotid Atherosclerosis Italian Ultrasound study (CAIUS), a multicenter , double-blind clinical trial, performed in 305 asymptomatic, moderately hy percholesterolemic patients. clearly demonstrated beneficial effects of pra vastatin on the carotid intima-media thickness (IMT) progression. The datab ase of the CAIUS study was examined in order to investigate the presence of a relationship. if any, between the activity of pravastatin on IMT progres sion rate and its hypocholesterolemic effect. Quantitative B-mode ultrasoun d imaging was used to quantify the individual mean maximum IMT progression rate in 3 years. In the overall group of patients (placebo and pravastatin) covariance analysis showed that while the variable 'treatment' (0 = placeb o, 1 = pravastatin) was significantly related to the reduction of IMT progr ession (F = 6.6, P = 0.01), the IMT progression did not correlate with the extent of LDL-C lowering (F = 0.00, P = 0.98). To further investigate this issue, the pravastatin treated group was stratified into quartiles of LDL-C reduction. In contrast to what was observed in the placebo group, in which a positive mean IMT progression rate was observed, independent of the exte nt of LDL-C reduction, no IMT progression was observed in any subgroup trea ted with pravastatin. No significant difference was found among quartiles a nd no trend could be identified. In conclusion, the effect of pravastatin t reatment on carotid IMT progression rate is beneficial; however the CAIUS s tudy demonstrated that lowering LDL-C by itself, does not explain the varia bility of beneficial changes in IMT. (C) 2000 Elsevier Science Inland Ltd. All rights reserved.