Change in Carotid Intima-Media Thickness in a High-Risk Group of Patients by Intensive Lipid-Lowering Therapy With Rosuvastatin Subanalysis of the JART Study

Hiroyoshi Yokoi; Ryuji Nohara; Hiroyuki Daida; Mitsumasa Hata; Kohei Kaku; Ryuzo Kawamori; Junji Kishimoto; Masahiko Kurabayashi; Izuru Masuda; Ichiro Sakuma; Tsutomu Yamazaki; Masayuki Yoshida; for the Justification for Atherosclerosis Regression Treatment (JART) Investigators

doi:10.1536/ihj.13-216

Clinical Studies

Change in Carotid Intima-Media Thickness in a High-Risk Group of Patients by Intensive Lipid-Lowering Therapy With Rosuvastatin

Subanalysis of the JART Study

Hiroyoshi Yokoi, Ryuji Nohara, Hiroyuki Daida, Mitsumasa Hata, Kohei Kaku, Ryuzo Kawamori, Junji Kishimoto, Masahiko Kurabayashi, Izuru Masuda, Ichiro Sakuma, Tsutomu Yamazaki, Masayuki Yoshida, for the Justification for Atherosclerosis Regression Treatment (JART) Investigators

Author information

Hiroyoshi Yokoi
Department of Cardiology, Kokura Memorial Hospital
Ryuji Nohara
Federation of National Public Service Personnel Mutual Aid Associations, Hirakata Kohsai Hospital
Hiroyuki Daida
Department of Cardiology, Juntendo University School of Medicine
Mitsumasa Hata
Department of Cardiovascular Surgery, Nihon University School of Medicine
Kohei Kaku
Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Kawasaki Medical School
Ryuzo Kawamori
Sportology Center, Juntendo University Graduate School of Medicine, supported by High Technology Research Center Grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan
Junji Kishimoto
Center for Clinical and Translational Research, Kyushu University Hospital
Masahiko Kurabayashi
Department of Medicine and Biological Science, Gunma University Graduate School of Medicine
Izuru Masuda
Takeda Hospital, Medical Examination Center
Ichiro Sakuma
Hokko Memorial Clinic Caress Sapporo
Tsutomu Yamazaki
Clinical Research Support Center, the University of Tokyo Hospital
Masayuki Yoshida
Department of Life Sciences and Bioethics, Graduate School of Medicine, Tokyo Medical and Dental University
for the Justification for Atherosclerosis Regression Treatment (JART) Investigators

Keywords: Atherosclerosis, Intensive statin therapy

JOURNAL FREE ACCESS

2014 Volume 55 Issue 2 Pages 146-152

DOI https://doi.org/10.1536/ihj.13-216

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Abstract

Carotid intima-media thickness (IMT), a measure of atherosclerosis, is modulated by multiple risk factors. Accordingly, comprehensive control of risk factors is indispensable for management of atherosclerosis. In this study, as a posthoc analysis of the JART Study we planned two analyses. In the main analysis, we evaluated the effect of intensive lipidlowering therapy with rosuvastatin on carotid IMT in high-risk patients. We also evaluated efficacy in the presence or absence of each risk factor using the full analysis population in the JART Study. Patients with low-density lipoprotein cholesterol (LDL-C) ≥ 140 mg/dL and max-IMT ≥ 1.1 mm were randomized to rosuvastatin or pravastatin therapy for 12 months. Dosages were allowed to increase to 10 mg/day and 20 mg/day to achieve LDL-goals (aggressive goals for rosuvastatin group and guideline goals for pravastatin group). For the main analysis, we assessed 200 high-risk patients (105 in the rosuvastatin group), as category III or secondary prevention according to the Japan Atherosclerosis Society guideline 2007, whereas we assessed 289 patients in the other analysis. Rosuvastatin significantly slowed the percentage change in mean-IMT at 12 months compared with pravastatin (1.40 ± 10.03% versus 6.43 ± 13.77%, P = 0.005). LDL-C was reduced by 48.1% in the rosuvastatin group and 27.9% in the pravastatin group. The rate of achieving the LDL-C goal was significantly greater in the rosuvastatin group compared with the pravastatin group (P < 0.001). Rosuvastatin slowed the change in mean-IMT in the presence of every risk factor. Thus, intensive lipid-lowering therapy reduced progression of carotid IMT in high-risk patients.

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