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

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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.

Original languageEnglish
Pages (from-to)1096-1107
Number of pages12
JournalJournal of atherosclerosis and thrombosis
Volume17
Issue number10
DOIs
Publication statusPublished - 01-01-2010

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Acute Coronary Syndrome
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Coronary Artery Disease
Lipids
LDL Cholesterol
HDL Cholesterol
Ultrasonics
Association reactions
Apolipoproteins B
Percutaneous Coronary Intervention
Labels
pitavastatin
Atorvastatin Calcium
Japan
Therapeutics
Incidence

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine
  • Biochemistry, medical

Cite this

Arai, Hidenori ; Hiro, Takafumi ; Kimura, Takeshi ; Morimoto, Takeshi ; Miyauchi, Katsumi ; Nakagawa, Yoshihisa ; Yamagishi, Masakazu ; Ozaki, Yukio ; Kimura, Kazuo ; Saito, Satoshi ; Yamaguchi, Tetsu ; Daida, Hiroyuki ; Matsuzaki, Masunori. / More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome - sub-analysis of JAPAN-ACS study. In: Journal of atherosclerosis and thrombosis. 2010 ; Vol. 17, No. 10. pp. 1096-1107.
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title = "More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome - sub-analysis of JAPAN-ACS study",
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.",
author = "Hidenori Arai and Takafumi Hiro and Takeshi Kimura and Takeshi Morimoto and Katsumi Miyauchi and Yoshihisa Nakagawa and Masakazu Yamagishi and Yukio Ozaki and Kazuo Kimura and Satoshi Saito and Tetsu Yamaguchi and Hiroyuki Daida and Masunori Matsuzaki",
year = "2010",
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Arai, H, Hiro, T, Kimura, T, Morimoto, T, Miyauchi, K, Nakagawa, Y, Yamagishi, M, Ozaki, Y, Kimura, K, Saito, S, Yamaguchi, T, Daida, H & Matsuzaki, M 2010, 'More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome - sub-analysis of JAPAN-ACS study', Journal of atherosclerosis and thrombosis, vol. 17, no. 10, pp. 1096-1107. https://doi.org/10.5551/jat.5660

More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome - sub-analysis of JAPAN-ACS study. / Arai, Hidenori; Hiro, Takafumi; Kimura, Takeshi; Morimoto, Takeshi; Miyauchi, Katsumi; Nakagawa, Yoshihisa; Yamagishi, Masakazu; Ozaki, Yukio; Kimura, Kazuo; Saito, Satoshi; Yamaguchi, Tetsu; Daida, Hiroyuki; Matsuzaki, Masunori.

In: Journal of atherosclerosis and thrombosis, Vol. 17, No. 10, 01.01.2010, p. 1096-1107.

Research output: Contribution to journalArticle

TY - JOUR

T1 - More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome - sub-analysis of JAPAN-ACS study

AU - Arai, Hidenori

AU - Hiro, Takafumi

AU - Kimura, Takeshi

AU - Morimoto, Takeshi

AU - Miyauchi, Katsumi

AU - Nakagawa, Yoshihisa

AU - Yamagishi, Masakazu

AU - Ozaki, Yukio

AU - Kimura, Kazuo

AU - Saito, Satoshi

AU - Yamaguchi, Tetsu

AU - Daida, Hiroyuki

AU - Matsuzaki, Masunori

PY - 2010/1/1

Y1 - 2010/1/1

N2 - 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.

AB - 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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