More Intensive Lipid Lowering is Associated with Regression of Coronary Atherosclerosis in Diabetic Patients with Acute Coronary Syndrome –Sub-Analysis of JAPAN-ACS Study

Hidenori Arai; Takafumi Hiro; Takeshi Kimura; Takeshi Morimoto; Katsumi Miyauchi; Yoshihisa Nakagawa; Masakazu Yamagishi; Yukio Ozaki; Kazuo Kimura; Satoshi Saito; Tetsu Yamaguchi; Hiroyuki Daida; Masunori Matsuzaki

doi:10.5551/jat.5660

Original Article

More Intensive Lipid Lowering is Associated with Regression of Coronary Atherosclerosis in Diabetic Patients with Acute Coronary Syndrome –Sub-Analysis of JAPAN-ACS Study

Hidenori Arai, Takafumi Hiro, Takeshi Kimura, Takeshi Morimoto, Katsumi Miyauchi, Yoshihisa Nakagawa, Masakazu Yamagishi, Yukio Ozaki, Kazuo Kimura, Satoshi Saito, Tetsu Yamaguchi, Hiroyuki Daida, Masunori Matsuzaki

Author information

Hidenori Arai
Department of Human Health Sciences, Kyoto University Graduate School of Medicine.
Takafumi Hiro
Division of Cardiology, Department of Medicine, Nihon University School of Medicine.
Takeshi Kimura
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine.
Takeshi Morimoto
Center for Medical Education, Kyoto University Graduate School of Medicine.
Katsumi Miyauchi
Department of Cardiology, Juntendo University School of Medicine.
Yoshihisa Nakagawa
Department of Cardiology, Tenri Hospital.
Masakazu Yamagishi
Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine.
Yukio Ozaki
Department of Cardiology, Fujita Health University.
Kazuo Kimura
Division of Cardiology, Yokohama City University Medical Center.
Satoshi Saito
Keiai Hospital.
Tetsu Yamaguchi
Toranomon Hospital.
Hiroyuki Daida
Department of Cardiology, Juntendo University School of Medicine.
Masunori Matsuzaki
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine.

Keywords: Acute coronary syndrome, Plaque, Statin, Intravascular ultrasound, Diabetes mellitus

JOURNAL OPEN ACCESS

2010 Volume 17 Issue 10 Pages 1096-1107

DOI https://doi.org/10.5551/jat.5660

View "Advance Publication" version (July 28, 2010).

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Abstract

Aim: We have shown that aggressive lipid lowering by pitavastatin and atorvastatin results in marked regression of atherosclerotic coronary lesions after acute coronary syndrome (ACS). The purpose of this study was to address the association of lipid levels after statin therapy with regression of atherosclerotic coronary lesions and major cardiovascular events in patients after ACS.
Methods: JAPAN-ACS is a prospective, randomized open-label study performed at 33 centers in Japan. Patients with ACS undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) were randomly assigned to receive either 4 mg/day pitavastatin or 20 mg/day atorvastatin within 72 hours after PCI. IVUS image was obtained in 251 patients, including 73 diabetic patients. Lipid profiles at the end of the study were divided into quartiles and the association with the percent change in non-culprit coronary plaque volume (PV) was assessed in total and diabetic patients. We also studied whether baseline and follow-up levels of HDL-cholesterol are associated with restenosis after PCI.
Results: Decreasing LDL-cholesterol, non-HDL-cholesterol, LDL-C/HDL-C ratio, apolipoprotein B quartiles were associated with a progressively smaller plaque burden in total and diabetic patients. In diabetic patients, further reduction of these parameters was associated with a significantly greater reduction in PV. We also found that patients with lower HDL-cholesterol had a significantly higher incidence of target lesion revascularization.
Conclusions: Early intensive statin therapy in patients after ACS results in remarkable regression of coronary PV. Diabetic patients can have a benefit with more intensive therapy to achieve a lower target level in Japanese.

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