Atherosclerosis measured by B-Mode ultrasonography: effect of statin therapy on disease progression

Abstract 

Changes in intima-media thickness (IMT) and arterial lumen diameter—as measured by B-mode high-resolution ultrasonography and quantitative coronary angiography, respectively—are currently the only surrogate markers for progression of atherosclerotic disease recognized by regulatory authorities in the United States and Europe. Because atherosclerosis is a disease of the arterial wall, the ability of B-mode ultrasonography to provide visualization of IMT offers significant advantages over angiography. These advantages, as well as the safety and noninvasiveness of B-mode ultrasonography, have led to increasing use of this imaging technique in observational studies and interventional studies of lipid-lowering agents over the last decade. These observational studies clearly demonstrated an association between carotid IMT and atherosclerotic disease. Of the interventional studies, the recent Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER) trial found that use of atorvastatin 80 mg daily for aggressive lowering of plasma low-density lipoprotein cholesterol (LDL-C) concentrations to below current target levels was associated with significant IMT regression compared with results obtained with less aggressive plasma LDL-C lowering. A new study—Measuring Effects on Intima Media Thickness: an Evaluation of Rosuvastatin (METEOR)—will examine the effects of aggressive lipid-lowering treatment with rosuvastatin 40 mg daily on IMT. The cohort in this study will be individuals with mild hypercholesterolemia whose standard risk assessment does not categorize them as at sufficient risk of clinical disease to warrant initiation of lipid-lowering therapy despite their relatively high IMT values.