Use of intravascular ultrasound to compare effects of different strategiesof lipid-lowering therapy on plaque volume and composition in patients with coronary artery disease

Background-We studied whether lipid-lowering therapy with atorvastatin (tar get LDL cholesterol [LDL-C] <100 mg/dL) compared with a moderate treatment regimen that used other lipid-lowering drugs led to a lesser progression of atherosclerosis and to different changes in plaque echogenicity in patient s with coronary artery disease. Methods and Results-This study was a 12-month, open-label, randomized, mult icenter trial, which used serial 3D intracoronary ultrasound to calculate p laque volume and plaque echogenicity. After transcatheter therapy, 131 pati ents were randomized (atorvastatin n=65, usual care n=66). The target plaqu e had to be a minor lesion (ie, a diameter stenosis of <50% on angiography) . After 12 months, mean LDL-C was reduced from 155 to 86 mg/dL in the atorv astatin group and from 166 to 140 mg/dL in the usual care group. Mean absol ute plaque volume showed a larger increase in the usual care group compared with the atorvastatin group (usual care 9.6 +/- 28.1 mm(3), atorvastatin 1 .2 +/- 30.4 mm(3); P=0.191). The hyperechogenicity index of the plaque incr eased to a larger extent for the atorvastatin group than for the usual care group, with a significant treatment effect for the percent change (atorvas tatin 42.2%, usual care 10.1%; P=0.021). Conclusions-One year of lipid-lowering therapy to <100 mg/dL LDL-C most lik ely led to a slowdown of plaque growth of minor lesions. The significantly larger increase in plaque hyperechogenicity is most likely due to a change in plaque composition.