Intensive lipid-lowering therapy ameliorates novel calcification markers and GSM score in patients with carotid stenosis

Objectives/Design. Carotid plaque echogenicity quantified by the Gray-Scale Median (GSM) score has been associated with plaque vulnerability. The aim of this study was to assess whether intensive lipid-lowering treatment with atorvastatin in patients with carotid artery stenosis ameliorates novel vascular calcification inhibitors, such as osteopontin (OPN) and osteoprotegerin (OPG), and improves GSM score. Methods. Ninety-seven patients with carotid stenosis (> 40%), but without indicationfor intervention, were treated for 6 months with atorvastatin (10 mg-80 mg) to target LDL < 100 mg/dl. Fifty-tWo age-and sex-matched healthy individuals served as the control group. Blood samples and GSM were obtained at the beginning and after 6 months. Results. Systolic blood pressure, hsCRP, fibrinogen, OPN and OPG levels differed significantly between patients with carotid stenosis and healthy controls at baseline (p < 0.05). Atorvastatin treatment improved lipid profile and significantly reduced hsCRP (p = 0.002), WBC count (p = 0.041), OPN (p < 0.001) and OPG levels (p < 0.001). GSM score increased considerably after atorvastatin therapy (from 58.33 +/- 24.38 to 79.33 +/- 22.3; p < 0.001) and that effect appeared related to OPN (p = 0.001), OPG (p = 0.013) and LDL (p =0.01) reduction. Conclusions. In patients with carotid stenosis, intensive lipid-lowering therapy with statins attenuates serum OPN and OPG levels and enhances carotid plaque echogenicity, outlining their beneficial effects on plaque stability. (c) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.