1
|
Tao L, Wang XH, Li XQ, Dai YJ, Yang BQ, Chen HS. Intracranial plaque with large lipid core is associated with embolic stroke of undetermined source. Ann Clin Transl Neurol 2023; 10:363-372. [PMID: 36599316 PMCID: PMC10014002 DOI: 10.1002/acn3.51726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate an association between percentage lipid-rich necrotic core (LRNC) and an index ischemic stroke in an embolic stroke of undetermined source (ESUS) cohort. METHODS A total of 167 ESUS patients with 259 non-stenotic intracranial plaques including 155 ipsilateral and 104 contralateral to stroke were finally enrolled in the current analysis. The multi-dimensional parameters involving remodeling index (RI), plaque burden (PB), LRNC, discontinuity of plaque surface (DPS), intraplaque hemorrhage (IPH), and vulnerable plaque defined as presence of complicated plaque were evaluated by high-resolution magnetic resonance imaging. RESULTS We found that %LRNC was an independent predictor for ESUS in model 1 (OR: 2.574, 95% CI: 1.854-3.573, P < 0.001), and model 2 (OR: 2.550, 95% CI: 1.835-3.545, P < 0.001), but the association was not seen in PB. In receiver operating characteristic curve analysis, the discrimination of LRNC for ESUS was significantly superior to that of PB (absolute difference: 0.121, 95% CI: 0.056-0.205, P < 0.001). Importantly, a significantly positive synergy between the remodeling pattern and LRNC in response to plaque vulnerability was found by Sankey diagram (P for interaction = 0.001). CONCLUSION This is the first report that LRNC, beyond PB, may be correlated with an index ESUS, and a synergistic effect between positive remodeling and larger LRNC could promote plaque vulnerability. The findings suggest that a potential target subgroup may benefit from stroke prevention with intensive statin, although this must be confirmed in future.
Collapse
Affiliation(s)
- Lin Tao
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Ying-Jie Dai
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| | - Ben-Qiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, ShenYang, China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, ShenYang, China
| |
Collapse
|
2
|
Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine. Curr Cardiol Rep 2019; 21:72. [DOI: 10.1007/s11886-019-1170-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
3
|
Lim JW, Jeong HS, Hong SJ, Kim HJ, Kim YC, Kang BG, Jeon SM, Cho JY, Lee SH, Joo HJ, Park JH, Yu CW. Effects of lowest-dose vs. highest-dose pitavastatin on coronary neointimal hyperplasia at 12-month follow-up in type 2 diabetic patients with non-ST elevation acute coronary syndrome: an optical coherence tomography analysis. Heart Vessels 2018; 34:62-73. [PMID: 30047013 DOI: 10.1007/s00380-018-1227-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Abstract
Current ACC/AHA guidelines recommend high-dose statin therapy after coronary stenting, especially in diabetic patients; however, pitavastatin 4 mg or pitavastatin 1 mg are frequently used after coronary stenting in Asia, even in patients with acute coronary syndrome. We compared the effects of highest-dose and lowest-dose pitavastatin therapy on coronary neointimal hyperplasia at 12-month follow-up in diabetic patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) using optical coherence tomography. A total of 72 diabetic patients with NSTE-ACS were randomized to lowest-dose pitavastatin [1 mg (n = 36)] or highest-dose pitavastatin [4 mg (n = 36)] after everolimus-eluting stent implantation. The primary endpoint was to compare the normalized neointimal volume at 12-month follow-up. Normalized neointimal volume was significantly lower in the pitavastatin 4 mg group (4.00 ± 2.80 vs. 8.24 ± 2.83 mm3/mm, p < 0.01) at 12-month follow-up. There was also significant difference in neointimal area between the pitavastatin 4 mg group and pitavastatin 1 mg group (0.41 ± 0.28 vs. 0.74 ± 0.23 mm2, p < 0.01). Improvement of brachial artery flow-mediated dilation (baFMD) was significantly higher in the pitavastatin 4 mg group than in pitavastatin 1 mg group (0.15 ± 0.15 vs. - 0.03 ± 0.19 mm, p < 0.001). In addition, the improvement of adiponectin levels was significantly greater in the pitavastatin 4 mg group than in the pitavastatin 1 mg group (2.97 ± 3.98 vs. 0.59 ± 2.80 μg/mL, p < 0.05). Pitavastatin 4 mg significantly improved inflammatory cytokines and lipid profiles compared to pitavastatin 1 mg during the 12-month follow-up, contributing to the reduction of neointimal hyperplasia and to the improvement of baFMD in diabetic patients with NSTE-ACS requiring coronary stenting. Thus, the administration of pitavastatin 4 mg can be safely and effectively used in high-risk patients requiring coronary stenting. Trial registration NCT02545231 (Clinical Trial registration information: https://clinicaltrials.gov/ct2/show/NCT02545231 ).
Collapse
Affiliation(s)
- Jung Wook Lim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Han Saem Jeong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Soon Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea.
| | - Hyo Jeong Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Young Chan Kim
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Bong Gyun Kang
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Su Min Jeon
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Jae Young Cho
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Seung Hoon Lee
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Hyung Joon Joo
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Jae Hyoung Park
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Cheol Woong Yu
- Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| |
Collapse
|
4
|
Kwan AC, Aronis KN, Sandfort V, Blumenthal RS, Bluemke DA. Bridging the gap for lipid lowering therapy: plaque regression, coronary computed tomographic angiography, and imaging-guided personalized medicine. Expert Rev Cardiovasc Ther 2017; 15:547-558. [PMID: 28657444 PMCID: PMC8286171 DOI: 10.1080/14779072.2017.1348228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Lipid-lowering therapy effectively decreases cardiovascular risk on a population level, but it remains difficult to identify an individual patient's personal risk reduction while following guideline directed medical therapy, leading to overtreatment in some patients and cardiovascular events in others. Recent improvements in cardiac CT technology provide the ability to directly assess an individual's atherosclerotic disease burden, which has the potential to personalize risk assessment for lipid-lowering therapy. Areas covered: We review the current unmet need in identifying patients at elevated residual risk despite guideline directed medical therapy, the evidence behind plaque regression as a potential marker of therapeutic response, and highlight state-of-the-art advances in coronary computed tomographic angiography (CCTA) for measurement of quantitative and qualitative changes in coronary atherosclerosis over time. Literature search was performed using PubMed and Google Scholar for literature relevant to statin therapy and residual risk, coronary plaque regression measurement, and CCTA assessment of quantitative and qualitative change in coronary atherosclerosis. Expert commentary: We discuss the potential ability of CCTA to guide lipid-lowering therapy as a bridge between population and personalized medicine in the future, as well as the potential barriers to its use.
Collapse
Affiliation(s)
- Alan C. Kwan
- Department of Medicine of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
| | - Konstantinos N. Aronis
- Department of Cardiology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - Veit Sandfort
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
| | - Roger S. Blumenthal
- Department of Cardiology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, 21287
| | - David A. Bluemke
- Radiology and Imaging Sciences Department of the National Institutes of Health, Bethesda, MD 20892
| |
Collapse
|
5
|
Kawashiri MA, Sakata K, Hayashi K, Gamou T, Kanaya H, Miwa K, Ueda K, Higashikata T, Mizuno S, Michishita I, Namura M, Nitta Y, Katsuda S, Okeie K, Hirase H, Tada H, Uchiyama K, Konno T, Ino H, Nagase K, Yamagishi M. Impact of combined lipid lowering and blood pressure control on coronary plaque: myocardial ischemia treated by percutaneous coronary intervention and plaque regression by lipid lowering and blood pressure controlling assessed by intravascular ultrasonography (MILLION) study. Heart Vessels 2016; 32:539-548. [PMID: 27798731 DOI: 10.1007/s00380-016-0910-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/14/2016] [Indexed: 11/29/2022]
Abstract
The aim of the study was to elucidate the aggressive reduction of both low-density lipoprotein cholesterol (LDL-C) and blood pressure (BP) reduced coronary atherosclerotic plaque volume compared with a standard treatment of LDL-C and BP in Japanese patients with coronary artery disease (CAD). This study is a prospective, randomized, and open-labelled with a blind-endpoint evaluation study. A total of 97 patients (81 men, mean age 62.0 ± 9.6) with CAD undergoing intravascular ultrasonography (IVUS)-guided percutaneous coronary intervention (PCI) were randomized, and 68 patients had IVUS examinations at baseline and at 18-24 months follow-up. Patients were randomly assigned to standard or aggressive strategies targeting LDL-C and a BP of 100 mg/dL and 140/90 mmHg vs. 70 mg/dL and 120/70 mmHg, respectively. The primary endpoint was the percent change in coronary plaque volume. Both standard and aggressive strategies succeeded to achieve target levels of LDL-C and BP; 74.9 ± 14.7 vs. 63.7 ± 11.9 mg/dL (NS) and 124.1 ± 9.4/75.8 ± 7.7 vs. 113.6 ± 9.6/65.8 ± 9.4 mmHg (systolic BP; NS, diastolic BP; p < 0.05), respectively. Both groups showed a significant reduction in the coronary plaque volume of -9.4 ± 10.7% and -8.7 ± 8.6% (NS) in standard and aggressive therapies, respectively. Both standard and aggressive intervention significantly regressed coronary plaque volume by the same degree, suggesting the importance of simultaneous reductions of LDL-C and BP for prevention of CAD.
Collapse
Affiliation(s)
- Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tadatsugu Gamou
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Honin Kanaya
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenji Miwa
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kosei Ueda
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | | | - Sumio Mizuno
- Department of Cardiology, Fukui Cardiovascular Center, Fukui, Japan
| | - Ichiro Michishita
- Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Masanobu Namura
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Yutaka Nitta
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Shoji Katsuda
- Department of Cardiology, Toyama Red Cross Hospital, Toyama, Japan
| | - Kazuyasu Okeie
- Department of Cardiology, Koseiren Takaoka Hospital, Takaoka, Japan
| | - Hiroaki Hirase
- Department of Internal Medicine, Takaoka Municipal Hospital, Takaoka, Japan
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Katsuharu Uchiyama
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Tetsuo Konno
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
| | - Hidekazu Ino
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | - Keisuke Nagase
- Division of Medical Sciences, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | | |
Collapse
|
6
|
Barrios V, Escobar C. Clinical benefits of pitavastatin: focus on patients with diabetes or at risk of developing diabetes. Future Cardiol 2016; 12:449-66. [DOI: 10.2217/fca-2016-0018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Despite attaining LDL-cholesterol targets, many patients with diabetes remain at risk of developing cardiovascular events. In addition, treatment with statins has been associated with a slight but significant increased risk of development of diabetes, particularly with high-intensity statins. Pitavastatin is a moderate- to high-intensity statin that effectively reduces LDL-cholesterol levels. Pitavastatin provides a sustained increase of HDL-cholesterol levels that may exhibit a neutral or positive effect on glucose metabolism, may not increase the risk of new-onset diabetes, may exhibit positive effects on renal function and urinary albumin excretion and the risk of drug–drug interactions is low. Therefore, it seems that pitavastatin should preferentially be considered in the treatment of dyslipidemia in diabetic patients or at risk of developing diabetes.
Collapse
|
7
|
Mitsuda T, Uemura Y, Ishii H, Takemoto K, Uchikawa T, Koyasu M, Ishikawa S, Miura A, Imai R, Iwamiya S, Ozaki Y, Kato T, Shibata R, Watarai M, Murohara T. Lipoprotein(a) levels predict adverse vascular events after acute myocardial infarction. Heart Vessels 2016; 31:1923-1929. [DOI: 10.1007/s00380-016-0823-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 12/19/2022]
|