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Hameed I, Shah SA, Aijaz A, Mushahid H, Farhan SH, Dada M, Khan AB, Amjad R, Alvi F, Murtaza M, Zuberi Z, Hamza M. Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis. Am J Cardiovasc Drugs 2024; 24:419-431. [PMID: 38578578 DOI: 10.1007/s40256-024-00642-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
AIM Statin therapy is considered the gold standard for treating hypercholesterolemia. This updated meta-analysis aims to compare the efficacy and safety of a low/moderate-intensity statin in combination with ezetimibe compared with high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (ASCVD). METHODS A systematic search of two databases (PubMed and Cochrane CENTRAL) was conducted from inception to January 2023 and a total of 21 randomized clinical trials (RCTs) were identified and included in the analysis. Data were pooled using Hedges's g and a Mantel-Haenszel random-effects model to derive standard mean differences (SMDs) and 95% confidence intervals (Cis). The primary outcome studied was the effect of these treatments on lipid parameters and safety events. RESULTS The results revealed that combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels (SMD= - 0.41; CI - 0.63 to - 0.19; P = 0.0002). There was no significant change in the levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), Apo A1, or Apo B. The safety of these treatments was assessed by the following markers alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine phosphokinase (CK), and a significant difference was only observed in CK (SMD: - 0.81; CI - 1.52 to - 0.10; P = 0.02). CONCLUSION This meta-analysis demonstrated that the use of low/moderate-intensity statin combination therapy significantly reduced LDL-C levels compared with high-intensity statin monotherapy, making it preferable for patients with related risks. However, further trials are encouraged to evaluate potential adverse effects associated with combined therapy.
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Affiliation(s)
- Ishaque Hameed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syeda Ayesha Shah
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ashnah Aijaz
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hasan Mushahid
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Syed Husain Farhan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Dada
- Department of Medicine, Ziauddin University, Karachi, Pakistan
| | - Adam Bilal Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Reeha Amjad
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fawad Alvi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustafa Murtaza
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zaid Zuberi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Hamza
- Department of Internal Medicine, Albany Medical Center, Albany, USA
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de Carvalho DC, Fonseca FAH, Izar MCDO, Silveira ALPA, Tuleta ID, do Amaral JB, Neves LM, Bachi ALL, França CN. Monocytes presenting a pro-inflammatory profile persist in patients submitted to a long-term pharmacological treatment after acute myocardial infarction. Front Physiol 2023; 13:1056466. [PMID: 36741809 PMCID: PMC9895791 DOI: 10.3389/fphys.2022.1056466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction: Although it is broadly known that monocyte recruitment is involved in atherosclerosis development and that, in accordance with the microenvironment, these cells can be modulated into three well-known subpopulations: Classical (CD14++CD16-), intermediate (CD14++CD16+), and non-classical (CD14+CD16++), the effects of treatment with different pharmacological strategies (based on lipid-lowering and antiplatelets) after acute myocardial infarction upon the monocytes modulation and the role of the chemokine receptors CCR2, CCR5 and CX3CR1 in this context, are poorly understood. Methods: In this study, patients [n = 148, both men (n = 105, 71%) and women (n = 43, 29%)] submitted to treatment with a 2×2 factorial design, in which they received rosuvastatin 20 mg or simvastatin 40 mg plus ezetimibe 10 mg, as well as ticagrelor 90 mg or clopidogrel 75 mg were enrolled. Monocyte subsets were analyzed by flow cytometry at baseline (BL), and after one (1-M) and 6 months (6-M) of treatment. Results: Firstly, our results showed that, regardless of the treatment received, higher percentages of classical monocytes and lower of non-classical monocytes were found at the 6-M time point than BL values, whilst the percentage of intermediate monocytes was higher in all time points assessed than the other subsets. There were reductions in the CCR2 expression by non-classical and intermediate monocytes, without differences for the classical subtype. Concerning the CCR5 expression, there were reductions in the three monocyte subtypes, whereas the CX3CR1 expression increased both in intermediate and classical monocytes, without differences for non-classical monocytes. In relation to the treatment received, a higher percentage of intermediate monocytes at the 6-M time point than the values BL was observed in the group treated with simvastatin + ezetimibe + clopidogrel. No significant differences were found concerning non-classical, intermediate, and classical monocytes, for CCR2, CCR5, and CX3CR1 in the four treatment arms. Conclusion: Taken together, our results demonstrated that even under lipid-lowering and antiplatelet therapy for 6 months, the inflammatory phenotype of monocytes still persisted in the patients enrolled in this study.
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Affiliation(s)
| | | | | | | | - Izabela Dorota Tuleta
- Department of Medicine-Cardiology, Albert Einstein College of Medicine, New York, NY, United States
| | - Jônatas Bussador do Amaral
- ENT Research Laboratory, Otorhinolaryngology-Head and Neck Surgery Department, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lucas Melo Neves
- Post Graduation Program in Health Sciences, Santo Amaro University, Sao Paulo, Brazil
| | | | - Carolina Nunes França
- Post Graduation Program in Health Sciences, Santo Amaro University, Sao Paulo, Brazil,*Correspondence: Carolina Nunes França,
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Atherosclerosis severity in patients with familial hypercholesterolemia: The role of T and B lymphocytes. ATHEROSCLEROSIS PLUS 2022; 48:27-36. [PMID: 36644561 PMCID: PMC9833267 DOI: 10.1016/j.athplu.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/01/2023]
Abstract
Background and aims Familial hypercholesterolemia (FH) is characterized by lifelong exposure to high LDL-c concentrations and premature atherosclerotic cardiovascular disease; nevertheless, disease severity can be heterogeneous.We aimed at evaluating if the immune-inflammatory system could modulate atherosclerosis burden in FH. Methods From a cohort of subjects with confirmed FH (Dutch Lipid Clinic Network and genotype), 92 patients receiving high-intensity lipid-lowering therapy (statin ± ezetimibe) were included. The extension and severity of coronary atherosclerosis was assessed by standardized reporting systems (CAD-RADS) for coronary computed tomography angiography (CCTA) and coronary artery calcium (CAC) scores. Lipids, apolipoproteins, anti-oxLDL and anti-apolipoprotein B-D peptide (anti-ApoB-D) autoantibodies (IgM and IgG), lymphocytes subtypes, platelet, monocyte and endothelial microparticles (MP), IgM levels (circulating or produced by B1 cells) and cytokines in the supernatant of cultured cells were determined. Multiple linear regression models evaluated associations of these biomarkers with CAC and CAD-RADS scores. Results In univariate analysis CAC correlated with age, systolic blood pressure, TCD4+ cells, and titers of IgM anti-ApoB-D. In multiple linear regression [ANOVA F = 2.976; p = 0.024; R2 = 0.082), CD4+T lymphocytes (B = 35.289; beta = 0.277; p = 0.010; 95%CI for B 8.727 to 61.851), was independently associated with CAC. CAD-RADS correlated with age, systolic blood pressure, titers of IgM anti-ApoB-D, and endothelial MP in univariate analysis. In multiple linear regression, [ANOVA F = 2.790; p = 0.032; R2 = 0.119), only age (B = 0.027; beta = 0.234; p = 0.049; 95% CI for B 0.000 to 0.053) was independent predictor. Conclusions In subjects with FH, under high-intensity lipid-lowering therapy, age and CD4+T cells were associated to atherosclerosis burden.
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Comparative safety and efficacy of low- or moderate-intensity statin plus ezetimibe combination therapy and high-intensity statin monotherapy: A meta-analysis of randomized controlled studies. PLoS One 2022; 17:e0264437. [PMID: 35245303 PMCID: PMC8896700 DOI: 10.1371/journal.pone.0264437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
Abstract
Statin is highly recommended for dyslipidemia to prevent atherosclerosis-related cardiovascular diseases and death. The aim of this study was to compare the efficacies and safeties of low/moderate-intensity statin plus ezetimibe combination therapy vs. high-intensity statin monotherapy. Meta-analysis was conducted on data included in published studies performed to compare the effects of the two treatments on lipid parameters and hs-CRP. Safety-related parameters were also evaluated. Eighteen articles were included in the meta-analysis. In terms of efficacy, low/moderate-intensity statin plus ezetimibe reduced LDL-C (SE = 0.307; 95% CI 0.153–0.463), TC (SE = 0.217; 95% CI 0.098–0.337), triglyceride (SE = 0.307; 95% CI 0.153–0.463), and hs-CRP (SE = 0.190; 95% CI 0.018–0.362) significantly more than high-intensity statin therapy. In terms of safety, the two treatments were not significantly different in terms of ALT elevation, but high-intensity statin increased AST and CK significantly more than combination therapy. This analysis indicates that low/moderate-intensity statin plus ezetimibe combined therapy is more effective and safer than high-intensity statin monotherapy, which suggests the addition of ezetimibe to statin should be preferred over increasing statin dose and that high-intensity statin should be used more carefully, especially in patients with related risks.
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Liu Y, Xia N, Hu W, Zhao W. Lipid-altering Efficacy of Ezetimibe/Simvastatin Compared with
Rosuvastatin in Hypercholesterolaemic Patients: A Meta-Analysis. INT J PHARMACOL 2019. [DOI: 10.3923/ijp.2019.200.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wang ECE, Dai Z, Christiano AM. Novel therapies for alopecia areata: The era of rational drug development. J Allergy Clin Immunol 2017; 141:499-504. [PMID: 29155099 DOI: 10.1016/j.jaci.2017.10.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 12/19/2022]
Abstract
Treatments for alopecia areata (AA) have evolved over the decades from broad and nonspecific therapies to those that are now more targeted and rationally selected. This was achieved by means of close cooperation and communication between clinicians and basic scientists, which resulted in the elucidation and understanding of the unique pathophysiology of AA. In this review we discuss this evolution and how novel therapies for AA have changed over the decades, what we have in our current arsenal of drugs for this potentially devastating disease, and what the future holds.
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Affiliation(s)
- Etienne C E Wang
- Department of Dermatology, Columbia University, New York, NY; National Skin Center, Singapore
| | - Zhenpeng Dai
- Department of Dermatology, Columbia University, New York, NY
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Fonseca FAH, Izar MC, Maugeri IML, Berwanger O, Damiani LP, Pinto IM, Szarf G, França CN, Bianco HT, Moreira FT, Caixeta A, Alves CMR, Soriano Lopes A, Klassen A, Tavares MFM, Fonseca HA, Carvalho ACC. Effects of four antiplatelet/statin combined strategies on immune and inflammatory responses in patients with acute myocardial infarction undergoing pharmacoinvasive strategy: Design and rationale of the B and T Types of Lymphocytes Evaluation in Acute Myocardial Infarction (BATTLE-AMI) study: study protocol for a randomized controlled trial. Trials 2017; 18:601. [PMID: 29258572 PMCID: PMC5735810 DOI: 10.1186/s13063-017-2361-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Early reperfusion of the occluded coronary artery during acute myocardial infarction is considered crucial for reduction of infarcted mass and recovery of ventricular function. Effective microcirculation and the balance between protective and harmful lymphocytes may have roles in reperfusion injury and may affect final ventricular remodeling. Methods/design BATTLE-AMI is an open-label, randomized trial comparing the effects of four therapeutic strategies (rosuvastatin/ticagrelor, rosuvastatin/clopidogrel, simvastatin plus ezetimibe/ticagrelor, or simvastatin plus ezetimibe/clopidogrel) on infarcted mass and left ventricular ejection fraction (LVEF) (blinded endpoints) in patients with ST-segment elevation myocardial infarction submitted to fibrinolytic therapy before coronary angiogram (pharmacoinvasive strategy). All patients (n = 300, 75 per arm) will be followed up for six months. The effects of treatment on subsets of B and T lymphocytes will be determined by flow-cytometry/ELISPOT and will be correlated with the infarcted mass, LVEF, and microcirculation perfusion obtained by cardiac magnetic resonance imaging. The primary hypothesis is that the combined rosuvastatin/ticagrelor therapy will be superior to other therapies (particularly for the comparison with simvastatin plus ezetimibe/clopidogrel) for the achievement of better LVEF at 30 days (primary endpoint) and smaller infarcted mass (secondary endpoint) at 30 days and six months. The trial will also evaluate the improvement in the immune/inflammatory responses mediated by B and T lymphocytes. Omics field (metabolomics and proteomics) will help to understand these responses by molecular events. Discussion BATTLE-AMI is aimed to (1) evaluate the role of subsets of lymphocytes on microcirculation improvement and (2) show how the choice of statin/antiplatelet therapy may affect cardiac remodeling after acute myocardial infarction with ST elevation. Trial registration ClinicalTrials.gov, NCT02428374. Registered on 28 September 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2361-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Francisco A H Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil.
| | - Maria Cristina Izar
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Ieda M L Maugeri
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Lucas P Damiani
- Hospital do Coração, Rua Desembargador Eliseu Guilherme, 147, São Paulo, Brazil
| | - Ibraim M Pinto
- Instituto Dante Pazzanese de Cardiologia, Avenida Dante Pazzanese 500, São Paulo, Brazil
| | - Gilberto Szarf
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Carolina N França
- Universidade Santo Amaro, Rua Professor Enéas de Siqueira 340, São Paulo, Brazil
| | - Henrique T Bianco
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Flavio T Moreira
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Adriano Caixeta
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Claudia M R Alves
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Soriano Lopes
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Aline Klassen
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Marina F M Tavares
- Universidade de São Paulo, Avenida Professor Lineu Prestes, 748, São Paulo, Brazil
| | - Henrique A Fonseca
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
| | - Antonio C C Carvalho
- Universidade Federal de São Paulo, Rua Loefgren 1350, 04040-001, São Paulo, SP, Brazil
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Abstract
Recent genetic and preclinical studies have increased our understanding of the immunopathogenesis of alopecia areata (AA). This has allowed expedited development of targeted therapies for the treatment of AA, and a paradigm shift in our approach and understanding of autoimmunity and the hair follicle. The synergy between preclinical studies, animal models, and translational studies has led to unprecedented advances in the treatment options for AA, ultimately benefiting patients who have had little recourse. In this review, we summarize the scientific field of contemporary AA research, and look forward to potential new technologies and developments.
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Kopprasch S, Bornstein SR, Bergmann S, Graessler J, Hohenstein B, Julius U. Long-term follow-up of circulating oxidative stress markers in patients undergoing lipoprotein apheresis by Direct Adsorption of Lipids (DALI). ATHEROSCLEROSIS SUPP 2017; 30:115-121. [PMID: 29096826 DOI: 10.1016/j.atherosclerosissup.2017.05.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Beyond its well-established efficacy in lowering atherogenic lipids and lipoproteins, DALI (Direct Adsorption of Lipids) apheresis has been shown to have acute anti-inflammatory and endothelium-protective effects. In the present study, we investigated long-term effects of DALI procedures on circulating oxidative stress markers. METHODS Thirteen patients involved in the study underwent regular DALI apheresis for nearly two years. At sessions 1, 40 and 80 conventional lipid status and changes of systemic oxidative stress markers (oxidized LDL, anti-oxidized LDL antibodies, advanced oxidation protein products (AOPP), and myeloperoxidase (MPO)) were examined. RESULTS DALI procedure efficiently reduced atherogenic lipids/lipoproteins. On day three after apheresis lipid parameters returned to pre-apheresis values. They showed no tendency to increase or to decrease over time. No significant differences were found between 1st, 40th and 80th sessions. In a similar way, levels of oxidative stress biomarkers acutely decreased after apheresis sessions and rebounded on day three after apheresis. No significant differences were observed between sessions 1, 40, and 80. CONCLUSION DALI apheresis repeatedly decreases atherogenic lipid/lipoprotein profile and oxidative stress biomarker levels during each session. Among all investigated parameters no longitudinal effects over two years could be observed.
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Affiliation(s)
- Steffi Kopprasch
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
| | - Stefan R Bornstein
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Sybille Bergmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Juergen Graessler
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Bernd Hohenstein
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Ulrich Julius
- Extracorporeal Treatment and Apheresis Center, Department of Internal Medicine III, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
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Ueno Y, Yamashiro K, Tanaka Y, Watanabe M, Miyamoto N, Shimada Y, Kuroki T, Tanaka R, Miyauchi K, Daida H, Hattori N, Urabe T. Rosuvastatin may stabilize atherosclerotic aortic plaque: transesophageal echocardiographic study in the EPISTEME trial. Atherosclerosis 2015; 239:476-82. [PMID: 25702618 DOI: 10.1016/j.atherosclerosis.2015.02.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/25/2015] [Accepted: 02/10/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Large atheromatous aortic plaques (AAPs) have been associated with ischemic stroke. There is little evidence to guide the therapeutic strategy for ischemic stroke associated with large AAPs. This study sought to analyze the temporal profile of AAPs after rosuvastatin therapy in Japanese patients with acute ischemic stroke. METHODS The Efficacy of Post-stroke Intensive Rosuvastatin Treatment for aortogenic Embolic stroke (EPISTEME) trial was a prospective, randomized, open-label study. Acute ischemic stroke patients with dyslipidemia and AAPs ≥4-mm-thick on transesophageal echocardiography (TEE) were enrolled and randomly allocated to either the group treated with 5 mg/day rosuvastatin or the control group. The primary endpoint was the changes in volume and composition of AAPs on repeat TEE after 6 months. High-echoic plaque area was analyzed using binary images. RESULTS A total of 24 Japanese patients (rosuvastatin 12; control 12) were included in the primary analysis. Rosuvastatin substantially reduced low-density lipoprotein cholesterol (LDL-C) compared to control (-42.1% vs. 1.4%, P < 0.001). Percent changes of high-echoic plaque areas were significantly increased in the rosuvastatin group, while they were decreased in the control group (65.8% vs -14.7%, P < 0.001). There was a significant linear correlation between percent increase in high-echoic plaque area and LDL-C decrease (r=-0.434, P=0.002). CONCLUSION Treatment with 5-mg rosuvastatin for 6 months might induce atheromatous aortic plaque stabilization together with marked LDL-C reduction in Japanese patients with ischemic stroke, which could provide evidence on which to base the therapeutic strategy for aortogenic brain embolism.
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Affiliation(s)
- Yuji Ueno
- Department of Neurology, Juntendo University Urayasu Hospital, Japan; Department of Neurology, Juntendo University School of Medicine, Japan.
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Yasutaka Tanaka
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
| | - Masao Watanabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
| | - Nobukazu Miyamoto
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
| | - Yoshiaki Shimada
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Takuma Kuroki
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Ryota Tanaka
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan
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