Carotid atherosclerosis: pharmacological modulation

The Carotid Atherosclerosis Italian Ultrasound study (CAIUS) is a multicenter, double-blind clinical trial, performed in 305 asymptomatic, moderately hypercholesterolemic patients which demonstrated a beneficial effect of pravastatin on the carotid intima-media thickness progression. In the present study the database of the CAIUS study was examined in order to investigate whether the antiatherosclerotic effect of pravastatin is associated with the hypocholesterolemic effect. Quantitative B-mode ultrasound imaging was used to quantify the individual mean maximum IMT progression rate in 3 years. In the overall group of patients (placebo and pravastatin) covariance analysis showed that while the treatment was significantly related to the reduction of IMT progression, the IMT progression did not correlate with the extent of LDL-C lowering. To further investigate this issue the pravastatin treated group was stratified into quartiles of LDL-C reduction. In contrast to what observed in the placebo group, that showed a positive IMT progression rate, all groups treated with pravastatin, independent of the extent of response in terms of LDL-C reduction, showed negative IMT changes. No significant difference was found among quartiles and no trend could be identified. In conclusion, the effect of pravastatin treatment on carotid IMT progression rate is beneficial; however the CAIUS study demonstrated that lowering LDL-C by itself, does not explain the variability of beneficial changes in IMT