Rosuvastatin combined with ramipril significantly reduced atheroma volume by anti-inflammatory mechanism: Comparative analysis with rosuvastatin alone by intravascular ultrasound

Background: We tested the effects of rosuvastatin combined with ramipril on atheroma volume and its mechanism in de novo, intermediate coronary artery disease. Methods: Subjects were randomly assigned to 2 treatment groups (rosuvastatin alone group; 20 mg/day, combined group; rosuvastatin 20 mg/day and ramipril 10 mg/day). Total atheroma volume per 10 mm segment (TAV/10 mm), percent atheroma volume per 10 mm segment (PAV/10 mm) in entire indexed segments and TAV(most10), PAV(most10) in a 10 mm subsegment with the greatest disease by intravascular ultrasound, and lipids, metabolic parameters (adiponectin, insulin sensitivity), biomarkers (hsCRP, matrix metalloproteinase-9) were analyzed at baseline and at 9-12 months follow-up. Results: A total of 40 patients (rosuvastatin group; 21, combined group; 19), 46 lesions (rosuvastatin group; 24, combined group; 22) were finally analyzed. Rosuvastatin alone significantly reduced TAV/10 mm (7.8 +/- 17.4%, p<0.001) but did not change PAV/10 mm, TAV(most10), PAV(most10) after therapy. In combined group, TAV/10 mm, TAV(most10), PAV(most10) were significantly reduced after therapy (-10.7 +/- 11.5%, -13.4 +/- 14.5%, -2.7 +/- 5.8%, p<0.001, <0.001 and p=0.04) but PAV/10 mm did not change. The magnitude of changes of all IVUS derived parameters did not differ significantly between 2 groups. Of interest, the most important factor for the changes of PAV(most10) was the percent changes of LDL cholesterol (beta=0.23, 95% CI [0.07-0.39], p=0.007) in rosuvastatin alone group and the changes in hsCRP (beta=1.89, 95% CI [0.63-3.14], p=0.005) and baseline fasting blood glucose (beta=0.06, 95% CI [0.01-0.11], p=0.02) in combined group by multivariate analysis. Conclusions: Rosuvastatin combined ramipril therapy significantly reduced atheroma volume that was related with anti-inflammatory effects. (C) 2011 Elsevier Ireland Ltd. All rights reserved.