Effect of moderate-intensity statin on carotid intraplaque neovascularization of coronary artery disease: a retrospective cohort study

Abstract

Background: Statin treatment can reduce atherosclerotic plaque as detected via invasive intracoronary methods. However, few studies have evaluated the effect of moderate-intensity statin therapy on carotid intraplaque neovascularization (IPN) using semiquantitative indices. This study thus aimed to assess the effect of statin on the carotid IPN of coronary artery disease with contrast-enhanced ultrasound (CEUS).

Methods: In this noncontrol, retrospective, cohort study, 35 inpatients who underwent coronary angiography, serial CEUS, and laboratory evaluations were consecutively enrolled from June 2020 to December 2022 at the Department of Cardiology, Chinese PLA General Hospital. All patients were administered moderate-intensity statin during serial CEUS, and continuous and categorical assessment of IPN and maximum plaque height (MPH) of carotid plaque was performed. Patients with a target low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L at 12-month follow-up were compared with those who did not reach the LDL-C 1.8 mmol/L target.

Results: From baseline to 12-month follow-up, there were significant differences in the LDL-C levels between patients (2.71±1.29 vs. 1.35±0.83 mmol/L), those with 12-month follow-up LDL-C <1.8 mmol/L (2.58±1.24 vs. 1.08±0.52 mmol/L), and those with 12-month follow-up LDL-C ≥1.8 mmol/L (3.24±1.44 vs. 2.56±0.85 mmol/L) all P values <0.05, with decreases of 41%, 49%, and 11% from baseline, respectively. The mean MPH (12 months to baseline) decreased from 2.47±0.63 to 2.22±0.60 mm (P<0.05), and the IPN also decreased from 1.15±0.62 to 0.58±0.56, representing a reduction of 0.57±0.59 from baseline (P<0.001). In the LDL-C <1.8 mmol/L patients, there were significant differences between baseline and 12 months in MPH (2.37±0.56 vs. 2.03±0.52 mm; P<0.05) and IPN (1.32±0.77 vs. 0.54±0.63; P<0.05) compared with those with a follow-up LDL-C ≥1.8 mmol/L. Patients with a follow-up LDL-C <1.8 mmol/L, compared with those with a follow-up LDL-C ≥1.8 mmol/L, showed a significantly greater reduction in MPH (-0.34±0.46 vs. -0.13±0.39; P<0.05) and IPN (-0.79±0.63 vs. -0.57±0.79; P<0.05). Additionally, patients with carotid IPN regression showed a higher percent change in LDL-C compared with those without carotid IPN regression (-53.31±23.20 vs. -29.55±19.47; P<0.05).

Conclusions: Controlling the LDL-C to <1.8 mmol/L under moderate-intensity statin can stabilize and reduce carotid IPN as detected by the semiquantitative noninvasive CEUS.

Keywords: Contrast-enhanced ultrasound (CEUS); coronary artery disease (CAD); intraplaque neovascularization (IPN); low-density lipoprotein cholesterol (LDL-C); moderate-intensity statin.

Figure 1

Enrollment of the study population. CAG, coronary angiography; US, ultrasound; CEUS, contrast-enhanced ultrasound; CAD, coronary artery disease; PCI, percutaneous coronary intervention; CABG, coronary artery bypass surgery; IPN, intraplaque neovascularization.

Figure 2

The change of IPN according to grade. At baseline, the number of patients with IPN grades 0, 1, 2, and 3 was respectively 3 (8.6%), 17 (48.6%), 13 (37.1%), and 2 (5.7%). After 12 months of moderate-intensity statin treatment, the number of carotid IPN regression patients was 24 (69%): 9 patients with IPN grade 1 were downgraded to IPN grade 0, 3 patients with IPN grade 2 were downgraded to IPN grade 0, 10 patients with IPN grade 2 were downgraded IPN grade 1, and 2 patients with IPN grade 3 were downgraded to IPN grade 2. IPN, intraplaque neovascularization.

Figure 3

Carotid IPN regression on CEUS. A 37-year-old male patient had IPN grade 1 of the right internal carotid artery as detected on CEUS at baseline. (A) After 1 year of regular moderate-intensity statin therapy, the neovascularization of the same carotid plaque regressed to IPN grade 0 (B). The red dotted lines indicate the carotid plaque, and the yellow arrow indicates the intraplaque contrast microbubbles. IPN, intraplaque neovascularization; CEUS, contrast-enhanced ultrasound.

Figure 4

Correlations between the regression of carotid IPN and the percent change of lipid profiles at 12 months. (A) There was no significant difference in percent change in HDL-C between the Regression and N-regression groups (23.63±36.94 vs. 11.47±20.85; P=0.32). (B) Patients with carotid IPN regression showed a higher percent change in LDL-C compared with patients without carotid IPN regression (mean ± standard deviation: −53.31±23.20 vs. −29.55±19.47; P<0.05). N-regression: patients without regression of carotid neovascularization. HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; IPN, intraplaque neovascularization.