Effects of statins on progression of coronary artery disease as measured by intravascular ultrasound

Abstract

Intravascular ultrasound (IVUS) is a novel technique that provides an accurate and reproducible method to measure atheroma burden. Statin drugs reduce both atherogenic lipoproteins and cardiovascular morbidity and mortality. Studies assessing the effect of statin treatment on atheroma burden have shown conflicting results. Hence, this meta-analysis was conducted to evaluate the impact of statin therapy on coronary atherosclerosis progression. A systematic search using PubMed, EMBASE, and Cochrane Library databases was performed. Heterogeneity of the studies was analyzed by Cochran's Q statistics. The significance of common treatment effect was assessed by computing common mean difference between the control and treatment groups. A two-sided α error of <0.05 was considered statistically significant (P<.05). Eight trials composed of 919 patients including a placebo group with 458 patients and a treatment group with 461 patients were used. Characteristics of both groups at baseline were similar without any significant difference between them. In the pooled analysis, the common mean difference of coronary atheroma volume between statin therapy and the placebo arm was -3.573 (confidence interval, -4.46 to -2.68; P<.01). This meta-analysis demonstrates that treatment with statins not only slows atherosclerotic plaque progression but may also lead to plaque regression.

Figure 1

Lipid lowering in the placebo and treatment groups. LDL indicates low‐density lipoprotein.

Figure 2

Change in plaque volume with statin therapy: mean difference between treatment and control. CI indicates confidence interval; REVERSAL, Reversal of Atherosclerosis With Aggressive Lipid Lowering study; GAIN, German Atorvastatin Intravascular Ultrasound study.