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118 Cardio Diabetes Medicine 2017

Study Study Population Sample Months Drug & On Treatment Median Change of Pav
Size Dose LDL-C
REVERSAL Stable CAD 654 18 mon 2.05 +0.2% (_0.3% to 0.5%),
Atorvastatin 80 p = 0.18 vs. baseline
ASTEROID Stable CAD 349 24 mon Rosuvas- 1.57 -0.79% (-1.21% to 0.53%),
tatin40 p <0.001 vs. baseline
SATURN Stable CAD 1039 24 mon 1.82 -0.99% (_1.19 to _0.63),
Atorvastatin 80 1.62 p <0.001 vs. baseline
Rosuvastatin40 1.22% (_1.52 to _0.90),
p < 0.001 vs. baseline
IBIS 4 STEMI 103 13 mon Rosuvasta- 1.90 0.90% (_1.56% to - 0.25%),
tin 40
p 1/4 0.007 vs. baseline
Table 2: REVERSAL, ASTEROID, SATURN, IBIS 4 are the four studies reporting statin-mediated plaque
regression and the results are summarized.

of plaque progression or regression In SATURN, diabetics achieved lower LDL-C levels
and showed similar PAV regression as did non-dia-
LDL-C levels were independent predictors of plaque
regression in both ASTEROID and SATURN [10]. betic patients overall (0.83 7 0.13% vs. 1.15 7 0.13%),
as well as in the setting of on-treatment LDL-C < 70
mg/dl (1.09 +/- 0.16% vs. 1.24 +/- 0.16%); PAV reduction
Diabetes mellitus and Higher systolic blood was lower in diabetics only when on-treatment LDL-C
pressure : was >70 mg/dl [12].
Continued plaque growth despite LDL-C levels below In ASTEROID : Atheroma regression was compara-
the recommended thresholds was associated with ble in patients with vs. without diabetes [0.9% (2.8
the presence of diabetes mellitus, higher systolic to 0.9) vs. 0.8% (3.0 to 0.8)] [4]. These findings are
blood pressure, and smaller increase in HDL-C [11].
in contrast with earlier observations obtained from a
Baseline PAV: Strongest multivariable predictor of pooled analysis of IVUS studies where diabetics had
PAV regression in SATURN was increased baseline an on-treatment LDL-C of 80mg/dl and displayed
PAV. PAV increase of 0.6% as compared with LDL-C levels
of 84 mg/dl and no significant progression of PAV
CRP:
in non-diabetics [13].
• Pivotal role of inflammation in atherosclerosis [1] Very high-intensity statins produce plaque regression
has also been reflected in serial IVUS studies.
among diabetics and reduce the differences in the
• In REVERSAL, reduction of C-reactive protein natural history of coronary atherosclerotic disease
(CRP) was identified as an independent predictor between patients with or without diabetes when very
of a reduction in plaque progression . low LDL-C levels (<70 mg/dl) are achieved.
• In SATURN non-increasing levels of CRP after Association between plaque regression and clinical
24 months of intensive statin therapy were inde- outcomes:
pendently associated with greater PAV regression
Coronary imaging studies have improved the under-
These insights not only signify inter individual varia- standingof the natural history of atherosclerosis and
tion, but also highlight the multifactorial nature and of the efficacy of anti-atherosclerotic medications on
complex pathobiology of atherosclerosis and rein- coronary plaque. Plaque stabilization or regression
force the need for intensive modification of global risk as defined by imaging end points translates into im-
beyond reduction of LDL-C in patients with coronary proved clinical outcomes. Plaque burden measured
artery disease. by IVUS correlates with established clinical risk fac-
tors and may predict subsequent clinical events .FiG2
Plaque regression in Diabetic patient
populations
Diabetic patients are at high risk of accelerated
plaque growth and ischemic events.

GCDC 2017