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Regression of Carotid and Femoral Artery Intima-Media Thickness in Familial Hypercholesterolemia
Treatment With Simvastatin
Pernette R. W. de Sauvage Nolting, MD, PhD;
Eric de Groot, MD, PhD;
Aeilko H. Zwinderman, PhD;
Rudolf J. A. Buirma, MD;
Mieke D. Trip, MD, PhD;
John J. P. Kastelein, MD, PhD
Arch Intern Med. 2003;163:1837-1841.
Objective To investigate whether high-dose simvastatin therapy could reduce carotid and femoral artery intima-media thickness (IMT) in patients with familial hypercholesterolemia (FH) to prevent cardiovascular disease.
Background Imaging of arterial walls with B-mode ultrasonography is increasingly used as a noninvasive surrogate marker of cardiovascular disease. Intervention trials using this modality have shown that by reducing risk factors, progression of atherosclerosis was inhibited.
Methods After a washout period of 6 weeks, all patients with FH started monotherapy with simvastatin, 80 mg/d, for 2 years. The primary end point was the change (in millimeters) of the mean combined far-wall IMT of predefined carotid and femoral arterial segments at 2 years.
Results We included a total of 153 patients with FH. Mean ± SD combined baseline IMT was 1.07 ± 0.23 mm. After treatment with simvastatin for 2 years, this IMT decreased by a mean of 0.081 mm (95% confidence interval, -0.109 to -0.053; P<.001), with its largest reduction in the femoral artery (-0.283 mm; P<.001). An actual decrease of combined IMT was seen in 69.8% of all patients.
Conclusions High-dose simvastatin therapy reduces arterial wall IMT in more than two thirds of the patients, with its largest effect on the femoral artery. Furthermore, patients with FH who were treated with both statin and antihypertensive medication experienced a significantly greater benefit in terms of IMT reduction.
From the Departments of Vascular Medicine (Drs de Sauvage Nolting, de Groot, Trip, and Kastelein) and Clinical Epidemiology and Biostatistics (Dr Zwinderman), Academic Medical Center, Amsterdam, the Netherlands; and the Department of Clinical Research, Merck, Sharp & Dohme, Haarlem, the Netherlands (Dr Buirma). The authors have no relevant financial interest in this article.
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