Background Angiographic studies of the regression of coronaryartery disease are invasive and costly, and they permit onlylimited assessment of changes in the extent of atheroscleroticdisease. Electron-beam computed tomography (CT) is noninvasiveand inexpensive. The entire coronary-artery tree can be studiedduring a single imaging session, and the volume of coronarycalcification as quantified with this technique correlates closelywith the total burden of atherosclerotic plaque.
Methods We conducted a retrospective study of 149 patients (61percent men and 39 percent women; age range, 32 to 75 years)with no history of coronary artery disease who were referredby their primary care physicians for screening electron-beamCT. All patients underwent base-line scanning and follow-upassessment after a minimum of 12 months (range, 12 to 15), anda volumetric calcium score was calculated as an estimate ofthe total burden of plaque. Treatment with 3-hydroxy-3-methylglutarylcoenzyme A (HMG-CoA) reductase inhibitors was begun at the discretionof the referring physician. Serial measurements of low-densitylipoprotein (LDL) cholesterol were obtained, and the changein the calcium-volume score was correlated with average LDLcholesterol levels.
Results One hundred five patients (70 percent) received treatmentwith HMG-CoA reductase inhibitors, and 44 patients (30 percent)did not. At follow-up, a net reduction in the calcium-volumescore was observed only in the 65 treated patients whose finalLDL cholesterol levels were less than 120 mg per deciliter (3.10mmol per liter) (mean [±SD] change in the score, –7±23percent; P=0.01). Untreated patients had an average LDL cholesterollevel of at least 120 mg per deciliter and at the time of follow-uphad a significant net increase in mean calcium-volume score(mean change, +52±36 percent; P<0.001). The 40 treatedpatients who had average LDL cholesterol levels of at least120 mg per deciliter had a measurable increase in mean calcium-volumescore (mean change, +25±22 percent, P<0.001), althoughit was smaller than the increase in the untreated patients.
Conclusions The extent to which the volume of atheroscleroticplaque decreased, stabilized, or increased was directly relatedto treatment with HMG-CoA reductase inhibitors and the resultingserum LDL cholesterol levels. These changes can be determinednoninvasively by electron-beam CT and quantified with use ofa calcium-volume score.
Source Information
From the Electron Beam Tomography Research Foundation (T.Q.C., P.R., N.J.L., D.J.R.) and Vanderbilt University (B.C.), both in Nashville. Presented in part at the 70th Scientific Sessions of the American Heart Association, Orlando, Fla., November 9–12, 1997.
Address reprint requests to Dr. Raggi at the EBT Research Foundation, 64 Valleybrook Dr., Hendersonville, TN 37075.
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