Regression of carotid and femoral artery intima-media thickness in familial hypercholesterolemia: treatment with simvastatin

• Published in: Archives of internal medicine (1960) Vol. 163; no. 15; p. 1837
• Main Authors: de Sauvage Nolting, Pernette R W, de Groot, Eric, Zwinderman, Aeilko H, Buirma, Rudolf J A, Trip, Mieke D, Kastelein, John J P
• Format: Journal Article
• Language: English
• Published: United States 11.08.2003
• Subjects: Adult; Aged; Anticholesteremic Agents - administration & dosage; Anticholesteremic Agents - therapeutic use; Cardiovascular Diseases - prevention & control; Carotid Arteries - diagnostic imaging; Carotid Arteries - drug effects; Carotid Arteries - pathology; Drug Administration Schedule; Female; Femoral Artery - diagnostic imaging; Femoral Artery - drug effects; Femoral Artery - pathology; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hyperlipoproteinemia Type II - blood; Hyperlipoproteinemia Type II - diagnostic imaging; Hyperlipoproteinemia Type II - drug therapy; Hyperlipoproteinemia Type II - pathology; Lipids - blood; Male; Middle Aged; Simvastatin - administration & dosage; Simvastatin - therapeutic use; Treatment Outcome; Tunica Intima - diagnostic imaging; Tunica Intima - drug effects; Tunica Intima - pathology; Tunica Media - diagnostic imaging; Tunica Media - drug effects; Tunica Media - pathology; Ultrasonography
• ISSN: 0003-9926; 1538-3679
• DOI: 10.1001/archinte.163.15.1837

To investigate whether high-dose simvastatin therapy could reduce carotid and femoral artery intima-media thickness (IMT) in patients with familial hypercholesterolemia (FH) to prevent cardiovascular disease. Imaging of arterial walls with B-mode ultrasonography is increasingly used as a noninvasive surrogate marker of cardiovascular disease. Intervention trials using this modality have shown that by reducing risk factors, progression of atherosclerosis was inhibited. After a washout period of 6 weeks, all patients with FH started monotherapy with simvastatin, 80 mg/d, for 2 years. The primary end point was the change (in millimeters) of the mean combined far-wall IMT of predefined carotid and femoral arterial segments at 2 years. We included a total of 153 patients with FH. Mean +/- SD combined baseline IMT was 1.07 +/- 0.23 mm. After treatment with simvastatin for 2 years, this IMT decreased by a mean of 0.081 mm (95% confidence interval, -0.109 to -0.053; P<.001), with its largest reduction in the femoral artery (-0.283 mm; P<.001). An actual decrease of combined IMT was seen in 69.8% of all patients. High-dose simvastatin therapy reduces arterial wall IMT in more than two thirds of the patients, with its largest effect on the femoral artery. Furthermore, patients with FH who were treated with both statin and antihypertensive medication experienced a significantly greater benefit in terms of IMT reduction.