Rosuvastatin reduces intima-media thickness in hypercholesterolemic subjects with asymptomatic carotid artery disease: the Asymptomatic Carotid Atherosclerotic Disease in Manfredonia (ACADIM) Study

Effects of Exercise Training and Statin Use in People Living with Human Immunodeficiency Virus with Dyslipidemia

PURPOSE

To evaluate the effects of the combination of exercise training (ET) and statins in people living with human immunodeficiency virus.

METHODS

This was a randomized, double-blind, placebo-controlled clinical trial. Eighty-three people living with human immunodeficiency virus were assigned to either placebo (PL), statins (STA), PL + ET (PLET) or STA + ET (STAET) groups. Volunteers assigned to STA and STAET groups were administered 10 mg of rosuvastatin, whereas the PL and PLET groups were administered a placebo. The PLET and STAET groups performed ET three times a week. Before and after the 12-wk follow-up, the volunteers underwent to anthropometric assessment and blood collection to evaluate lipid profile, cardiovascular markers, inflammatory profile; a Doppler ultrasound examination, muscle strength (MS) and cardiorespiratory fitness (CF) tests were performed.

RESULTS

There was a decrease in total cholesterol, triglycerides, low-density lipoprotein, C-reactive protein, fibrinogen, interleukin (IL)-1β and right carotid intima-media thickness in the STA, PLET, and STAET groups compared with PL group (P < 0.001). Furthermore, there was a decrease in total cholesterol, triglycerides, low-density lipoprotein, IL-1β, IL-6, and IL-8 levels and in left and right carotid intima-media thickness and an increase in HDL-c levels in the STAET groups compared with the STA (P ≤ 0.001) and PLET groups (P ≤ 0.001). There was an increase in IL-10 levels, peak-systolic velocity, end-diastolic velocity, wall shear rate in the PLET and STAET groups compared with the PL (P ≤ 0.001) and STA groups (P ≤ 0.001). The PLET and STAET groups reduced body fat mass, body fat percentage and increased lean body mass, MS and CF compared with PL (P ≤ 0.001) and STA (P ≤ 0.001) groups.

CONCLUSIONS

The combination of ET and statins is useful to enhance lipid and inflammatory profiles, reduce cardiovascular disease markers, and improve Doppler ultrasound findings, MS and CF in people living with HIV.

The relationship between carotid intima-media thickness and global atherosclerosis

Background

The aim of this study was to investigate the relationship between (i) carotid intima–media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (ΔCIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA).

Methods and results

In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ΔCIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306).

Results

Carotid intima–media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ΔCIMT and TAS (P = 0·41).

Conclusions

In the present study, CIMT, but not ΔCIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis.

Automatic segmentation of carotid B-mode images using fuzzy classification

This paper presents a new method for the automatic segmentation of the common carotid artery in B-mode images. This method uses the instantaneous coefficient of variation edge detector, fuzzy classification of edges and dynamic programming. Several discriminating features of the intima and adventitia boundaries are considered, like the edge strength, the intensity gradient orientation, the valley shaped intensity profile and contextual information of the region delimited by those boundaries. The adopted fuzzy classification of edges helps avoiding low-pass filtering. The method is suited to real-time processing and user interaction is not required. Both the near and far wall boundaries can be detected in arteries with plaques of different types and sizes. Both expert manual and automatic tracings are significantly better for the far wall, due to the better visibility of the intima and adventitia boundaries. The automatic detection of the far wall shows an accuracy similar to the manual detections. For this wall, the error coefficient of variation for the mean intima-media thickness is in the range [5.6, 6.6 %] for automatic detections and in [6.7, 7.1 %] for manual ones. In the case of the near wall, the same coefficient of variation is in [11.2, 13.0 %] for automatic detections and in [5.9, 9.0 %] for manual detections. The mean intima-media thickness measurement errors observed for the far wall [Formula: see text] are among the best values reported for other fully automatic approaches. The application of this approach in clinical practice is encouraged by the results for the far wall and the short processing time (mean of 2.1 s per image).

Effect of intensive lipid-lowering therapy with rosuvastatin on progression of carotid intima-media thickness in Japanese patients: Justification for Atherosclerosis Regression Treatment (JART) study

BACKGROUND

A recent trial in Western countries has shown that rosuvastatin slows progression of carotid intima-media thickness (IMT) in patients with modest carotid IMT thickening and elevated levels of low-density lipoprotein cholesterol (LDL-C). We conducted a prospective, randomized, open-label, blinded-endpoint trial to determine whether rosuvastatin is more effective than pravastatin in slowing progression of carotid IMT in Japanese patients.

METHODS AND RESULTS

Adult patients with hypercholesterolemia who had a maximum IMT ≥1.1mm were randomly assigned to receive rosuvastatin or pravastatin. The primary endpoint was the percent change in the mean-IMT, which was measured by a single observer who was blinded to the treatment assignments. The trial was stopped on April 2011 according to the recommendation by the data and safety monitoring committee. A total of 348 patients (173 rosuvastatin; 175 pravastatin) were enrolled and 314 (159 rosuvastatin; 155 pravastatin) were included in the primary analysis. Mean (SD) percentage changes in the mean-IMT at 12 months were 1.91% (10.9) in the rosuvastatin group and 5.8% (12.0) in the pravastatin group, with a difference of 3.89% (11.5) between the groups (P=0.004). At 12 months, 85 patients (59.4%) in the rosuvastatin group achieved a LDL-C/high-density lipoprotein cholesterol ratio ≤1.5 compared with 24 patients (16.4%) in the pravastatin group (P<0.0001).

CONCLUSIONS

Rosuvastatin significantly slowed progression of carotid IMT at 12 months compared with pravastatin.

Carotid intima-media thickness and cardiovascular risk

Cardiovascular disease is the primary cause of death in most developed nations. Identifying an individual's cardiovascular risk remains a challenge. Traditional coronary-risk stratification is based on cardiovascular risk factors using risk score systems, which may not reliably identify atherosclerosis in asymptomatic individuals. Carotid intima-media thickness measured by ultrasonography is a noninvasive, well-validated tool that has been used as a surrogate for clinical coronary events. Carotid intima-media thickness has demonstrable utility as an independent predictor of future cardiovascular events. Recent data have improved our understanding of its applications as a screening tool for cardiovascular disease.

Dose-dependent effect of rosuvastatin in the regulation of metalloproteinase expression

BACKGROUND

The importance of rosuvastatin at therapeutic dosage in regulating the release, activity, protein level, and expression of matrix metalloproteinases (MMP)-2 and MMP-9 was investigated.

METHODS

Human umbilical artery smooth muscle cells were stimulated, in vitro, in a serum-free medium with rosuvastatin at various concentrations (2, 4, 7, and 10 ng/mL, which correspond to the maximal plasma concentration observed in healthy men after a daily oral intake of 5, 10, 20, and 40 mg, respectively). The release of MMP-2 and MMP-9 in the conditioned medium was assessed by enzyme-linked immunosorbent assay and confirmed by Western blot, the activity and expression were determined by zymography and polymerase chain reaction, respectively.

RESULTS

Human umbilical artery smooth muscle cells stimulated with rosuvastatin at 7 and 10 ng/mL had a significant lower release, activity, protein level, and expression of MMP-2 and MMP-9, when compared with those stimulated at 2 and 4 ng/mL (MMP-2 =p < 0.0001 and p < 0.0001, respectively; MMP-9 =p < 0.0001 and p < 0.0001, respectively).

CONCLUSION

The effects of rosuvastatin in reducing MMP-2 and MMP-9, which might stabilize the atherosclerotic plaques, are dose-dependent.

A state of the art review on intima-media thickness (IMT) measurement and wall segmentation techniques for carotid ultrasound

Last 10 years have witnessed the growth of many computer applications for the segmentation of the vessel wall in ultrasound imaging. Epidemiological studies showed that the thickness of the major arteries is an early and effective marker of onset of cardiovascular diseases. Ultrasound imaging, being real-time, economic, reliable, safe, and now seems to become a standard in vascular assessment methodology. This review is an attempt to discuss the most performing methodologies that have been developed so far to perform computer-based segmentation and intima-media thickness (IMT) measurement of the carotid arteries in ultrasound images. First we will present the rationale and the clinical relevance of computer-based measurements in clinical practice, followed by the challenges that one has to face when approaching the segmentation of ultrasound vascular images. The core of the paper is the presentation, discussion, benchmarking and evaluation of different segmentation techniques, including: edge-detection, active contours, dynamic programming, local statistics, Hough transform, statistical modeling, and integration of these approaches. Also, we will discuss and compare the different performance metrics that have been proposed and used to perform the validation. Best performing user-dependent techniques show an average IMT measurement error of about 1μm when compared to human tracings [57], whereas completely automated techniques show errors of about 10μm. The review ends with a discussion about the current standards in carotid wall segmentation and in an overview of the future perspectives, which may include the adoption of advanced and intelligent strategies to let the computer technique measure the IMT in the image portion where measurement is more reliable.

Pediatric triglycerides predict cardiovascular disease events in the fourth to fifth decade of life

To assess relationships between pediatric lipids and subsequent cardiovascular disease (CVD) in the fourth to fifth decades, we conducted 22- to 31-year follow-up studies (1998-2003) in former schoolchildren first studied in 1973-1976. The follow-up included 53% of eligible former subjects. We compared pediatric and adult body mass (in kilograms per square meter) and lipids in 19 cases with at least 1 CVD event and in 789 CVD event-free subjects. Mean +/- SD age was 12.3 +/- 3.3 years at entry and 38.5 +/- 3.8 years at follow-up. Mean age at the first CVD event was 37.1 +/- 4.9 years. The major novel finding of our study was that childhood triglycerides (TG) were consistently and independently associated with young adult CVD. The distributions of both childhood and adult TG were shifted to higher levels in the cases than controls. Of the 19 cases, 7 (37%) had childhood TG greater than the pediatric 95th percentile (153 mg/dL); and 6 of these 7 had high TG (>/=150 mg/dL) at adult follow-up. Overall, 61% of cases had high TG as adults. After adjusting for age, sex, and race, by analysis of variance, cases had higher TG levels both in childhood and in young adulthood. A bootstrapping method and the Cox proportional hazard analysis were used to predict CVD in the cohort with explanatory variables sex; race; childhood body mass index, low-density lipoprotein, log high-density lipoprotein cholesterol, and log TG; and adult cigarette smoking and type 2 diabetes mellitus. Childhood TG level was a significant, independent explanatory variable for young adult CVD hazard (hazard ratio, 5.35; 95% confidence interval, 1.69-20.0 for each 1-unit increase in natural logarithm scale) along with adult type 2 diabetes mellitus (hazard ratio, 19.4; 95% confidence interval, 4.24-114.2). Pediatric hypertriglyceridemia appears to be a significant, independent, potentially reversible correlate of young adult CVD.

Efficacy, effectiveness and real life goal attainment of statins in managing cardiovascular risk

Statins became available for the treatment of hypercholesterolemia in 1987. Multiple, well-designed, placebo-controlled, double-blind studies revealed that each 1% reduction in serum cholesterol level was associated with about 1% reduction in risk of cardiovascular events. Low-density lipoprotein (LDL) cholesterol reduction to less than 78 mg/dL may be associated with reduction of atheroma burden. Patients with high levels of high specificity C-reactive protein and having LDL cholesterol less than 3.4 mmol/L (130 mg/dL) in primary prevention settings benefited from aggressive LDL cholesterol reduction with rosuvastatin over a 2-year period. However, in real life practice, about half of patients who are prescribed statins discontinue the medication by the end of the year. Medication adherence is lower in younger patients, women, and absence of known coronary heart disease. Personal features of the prescribing physician and dispensing pharmacies also affect patients’ compliance. More studies are needed to evaluate if “compliance packets” would benefit patients in a real life situation.