Determinants of Arterial Wall Remodeling During Lipid-Lowering Therapy

作者：Paul Schoenhagen, E. Murat Tuzcu, Carolyn Apperson-Hansen, Chaohui Wang, Kathy Wolski, Songhua Lin, İlke Sipahi, Stephen J. Nicholls, William A. Magyar, Aaron Loyd, Tammy Churchill, Tim Crowe, Steven E. Nissen · 发表于：Circulation · 年份：2006 · DOI：10.1161/circulationaha.105.585703 · 被引用次数：155 · 研究领域：Coronary Interventions and Diagnostics、Cardiovascular Health and Disease Prevention、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: Coronary plaque progression and instability are associated with expansive remodeling of the arterial wall. However, the remodeling response during plaque-stabilizing therapy and its relationship to markers of lipid metabolism and inflammation are incompletely understood. METHODS AND RESULTS: Serial intravascular ultrasound (IVUS) data from the Reversal of Atherosclerosis with Aggressive Lipid Lowering Therapy (REVERSAL) trial were obtained during 18 months of intensive versus moderate lipid-lowering therapy. In a subgroup of 210 patients, focal coronary lesions with mild luminal narrowing were identified. Lumen area, external elastic membrane (EEM) area, and plaque area were determined at the lesion and proximal reference sites at baseline and during follow-up. The remodeling ratio (RR) was calculated by dividing the lesion EEM area by the reference EEM area. The relationship between the change in remodeling, change in plaque area, lipid profile, and inflammatory markers was examined. At the lesion site, a progression in plaque area (8.9+/-25.7%) and a decrease in the RR (-3.0+/-11.2%) occurred during follow-up. In multivariable analyses, the percentage change in plaque area (P<0.0001), baseline RR (P<0.0001), baseline lesion lumen area (0.019), logarithmic value of the change in high-sensitivity C-reactive protein (P=0.027), and hypertension at baseline (P=0.014) showed a significant, direct relation with the RR at follow-up. Lesion location in the right coronary...