18 Apr Regression of Atherosclerosis Linked to Decrease in Cardiac and All-Cause Mortality
MedicalResearch.com Interview with:
Gjin Ndrepepa, MD
Deutsches Herzzentrum München
München, Germany
Medical Research: What is the background for this study?
Dr. Ndrepepa: Prevention of atherosclerosis or promotion of its regression when it had developed, are among the greatest problems in clinical medicine. Recent imaging studies have shown that high-intensity statin therapy slows progression and may even result in regression of atherosclerosis. Despite the positive results in terms of retardation of progression or regression of atherosclerosis, the number of clinical events in these studies was too small to allow meaningful analysis of the relationship between slow progression or regression of atherosclerosis and morbidity or mortality and to date no specifically designed studies have been performed to investigate the association of progression or regression of the atherosclerosis with the long-term mortality. In the current study we addressed this clinically relevant problem.
Medical Research: What are the main findings?
Dr. Ndrepepa: In brief, the main findings of current study may be summarized as follows:
- 1) Progression of atherosclerosis in patients with coronary artery disease treated with statins and other secondary prevention measures was associated with 2.5-fold increase in the adjusted risk of 8-year cardiac mortality compared to patients with no progression/regression of atherosclerosis.
- 2) Regression of atherosclerosis was associated with a significant decrease in the risk of 8-year all-cause and cardiac mortality (75% and 80% reduction, respectively).
- 3) Diabetes mellitus increased the odds of progression and decreased the odds of regression of coronary artery atherosclerosis.
Medical Research: What should clinicians and patients take away from your report?
Dr. Ndrepepa: The present study may have some implications.
- First, the study showed that slowed progression or regression of coronary atherosclerosis is feasible in patients with coronary artery disease treated with statin therapy and other measures of secondary prevention and is associated with improved long-term survival. This underscores the importance of secondary prevention measures including aggressive lipid-lowering therapies.
- Second, by finding a strong association between regression of atherosclerosis and long-term mortality the present study supports the use of regression of atherosclerosis as an intermediate end point in anti-atherosclerotic interventional studies. This may be particularly important considering that in present-day clinical trials, mortality has become a rare event and large numbers of patients would be required to assess the efficacy of investigational anti-atherosclerotic therapies with mortality as an end point.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Ndrepepa: Despite evidence offered in this study on the association between coronary atherosclerosis progression or regression with long-term mortality, this issue should be further investigated in specifically designed prospective studies. In particular the impact of atherosclerosis progression on the occurrence of non-fatal coronary events such nonfatal myocardial infarction or the rates of revascularization and factors that promote atherosclerosis progression or regression need further investigation.
Medical Research: Is there anything else you would like to add?
Dr. Ndrepepa: The cardiology community should strive to ensure that the implementation of strategies to slow progression of coronary atherosclerosis or promote its regression becomes a central component of our practice in the coming years.
Citation:
Association of Progression or Regression of Coronary Artery Atherosclerosis with Long-term Prognosis
Ndrepepa, Gjin et al.
American Heart Journal Published Online: April 15, 2016
DOI: http://dx.doi.org/10.1016/j.ahj.2016.03.016
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Last Updated on April 18, 2016 by Marie Benz MD FAAD