Intensification of Statin Therapy Results in a Rapid Reduction in Atherosclerotic Inflammation: Results of a Multicenter Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Feasibility Study

• Published in: Journal of the American College of Cardiology Vol. 62; no. 10; p. 909
• Main Authors: TAWAKOL, Ahmed, FAYAD, Zahi A, NUNES, Irene O, BEALS, Chan R, SHANKAR, Sudha S, MOGG, Robin, ALON, Achilles, KLIMAS, Michael T, DANSKY, Hayes, SUBRAMANIAN, Sharath S, ABDELBAKY, Amr, RUDD, James H. F, FARKOUH, Michael E
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 03.09.2013
• Subjects: Adult; Aged; Aged, 80 and over; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - pathology; Atherosclerosis (general aspects, experimental research); Atherosclerosis - diagnostic imaging; Atherosclerosis - drug therapy; Atorvastatin; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Double-Blind Method; Feasibility Studies; Female; Fluorodeoxyglucose F18; Heart; Heptanoic Acids - administration & dosage; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Inflammation - diagnostic imaging; Inflammation - drug therapy; Male; Medical sciences; Middle Aged; Multimodal Imaging - methods; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - drug therapy; Positron-Emission Tomography - methods; Pyrroles - administration & dosage; Pyrroles - therapeutic use; Treatment Outcome; Radionuclide study; Radiodiagnosis; Multicenter study; Cardiovascular disease; Statin derivative; Inflammation; Result; Vascular disease; Reduction; Treatment; Atherosclerosis; Medical imagery; Feasibility; Computerized axial tomography; Circulatory system; Cardiology; Positron emission tomography; Antilipemic agent; Emission tomography; CRP; atherosclerosis; AC; plaque; C-reactive protein; TBR; 2-18F-fluoro-2-deoxy-D-glucose; FDG; atorvastatin; low-density lipoprotein; standardized uptake value; attenuation correction; LDL; SUV; inflammation; statins; PET/CT; target-to-background ratio; positron emission tomography-computed tomographic imaging; most diseased segment; MDS
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2013.04.066

The study sought to test whether high-dose statin treatment would result in greater reductions in plaque inflammation than low-dose statins, using fluorodeoxyglucose-positron emission tomography/computed tomographic imaging (FDG-PET/CT). Intensification of statin therapy reduces major cardiovascular events. Adults with risk factors or with established atherosclerosis, who were not taking high-dose statins (n = 83), were randomized to atorvastatin 10 versus 80 mg in a double-blind, multicenter trial. FDG-PET/CT imaging of the ascending thoracic aorta and carotid arteries was performed at baseline, 4, and 12 weeks after randomization and target-to-background ratio (TBR) of FDG uptake within the artery wall was assessed while blinded to time points and treatment. Sixty-seven subjects completed the study, providing imaging data for analysis. At 12 weeks, inflammation (TBR) in the index vessel was significantly reduced from baseline with atorvastatin 80 mg (% reduction [95% confidence interval]: 14.42% [8.7% to 19.8%]; p < 0.001), but not atorvastatin 10 mg (% reduction: 4.2% [-2.3% to 10.4%]; p > 0.1). Atorvastatin 80 mg resulted in significant additional relative reductions in TBR versus atorvastatin 10 mg (10.6% [2.2% to 18.3%]; p = 0.01) at week 12. Reductions from baseline in TBR were seen as early as 4 weeks after randomization with atorvastatin 10 mg (6.4% reduction, p < 0.05) and 80 mg (12.5% reduction, p < 0.001). Changes in TBR did not correlate with lipid profile changes. Statin therapy produced significant rapid dose-dependent reductions in FDG uptake that may represent changes in atherosclerotic plaque inflammation. FDG-PET imaging may be useful in detecting early treatment effects in patients at risk or with established atherosclerosis.