Author + information
- Paul Luiiendiik,
- Berto Bouma,
- Joris Vriend,
- Hubert Vliegen,
- Maarten Groenink,
- Eric De Groot,
- Petronella Pieper,
- Arie van Dijk,
- Gert-Jan Sieswerda,
- Gerrit Veen,
- Aeilko Zwinderman and
- Barbara Mulder
Patients after coarctation repair (CoA) demonstrate an increased cardiovascular risk. Carotid intima-media thickness (CIMT) a reliable marker for atherosclerosis is increased in (CoA). HMG-coA-reductase-inhibitors (statins) have been proven to reduce CIMT and clinical events. The aim of our study was to evaluate the effect of statins on the vascular wall in CoA.
We designed a multicentre, prospective, randomised, open label trial with blind endpoint (PROBE design) to evaluate the effect of Atorvastatin 80 mg once daily on CIMT progression during 3 year follow-up. The primary endpoint in this study was CIMT measured by B mode ultrasonography. Secondary endpoints were mortality and morbidity due to cardiovascular disease, serum lipids and 24h ambulatory blood pressures.
A total of 130 patients were enrolled (Atorvastatin = 66, No treatment = 64), of which 42 (64%) were on antihypertensive therapy in the statin group versus 42 (65%) in the group without treatment (P = 0.49). There was no significant effect of statin treatment on CIMT progression (treatment effect −0.005, 95%CI, −0.039–0.029; P= 0.76). In neither groups significant CIMT progression was found. Baseline CIMT was significantly higher in hypertensive as compared to normotensive CoA(0.61±0.98 mm vs 0.69± 0.16; P= 0.002). Regression analysis revealed that hypertension (ß = 0.004, P = < 0.001) was the strongest predictor for CIMT progression besides age (ß = 0.043, P = 0.031) and cholesterol (ß = 0.040, P = 0.027). A significant effect of statins on serum total cholesterol levels and serum LDL levels was found. (−0.71, 95% CI, −1.16 – −0.26; P = 0.002 vs −0.66 −1.06 – −0.26; P = 0.001). There was no difference in the remaining secondary outcome measures.
Hypertension is the strongest predictor for CIMT progression in CoA. Treatment with statins does not reduce CIMT progression and secondary outcome measures, despite a decrease in serum total cholesterol and LDL. These findings suggest that the damaging effect of hypertension predominates the effect of statin therapy on the vascular wall. Future trials with anti-hypertensive agents are needed to evaluate the beneficial effect on the vascular wall in CoA.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Congenital Cardiology Solutions: New Insights into Congenital Heart Disease in the Adult
Abstract Category: 12. Congenital Cardiology Solutions: Adult
Presentation Number: 1249M-138
- 2013 American College of Cardiology Foundation