Recently, new insights have become available into how anti-inflammatory effects of statin treatment impact on what happens within the coronary arteries. As seen in the REVERSAL trial, for example, a reduction in systemic inflammation, as indicated by the level of C-reactive protein, was important in addition to cholesterol-lowering, for the regression of atheroma volume in patients with coronary artery disease who underwent statin treatment (1). Statin treatment has also been associated with reduced thermal heterogeneity in culprit lesions, indicating a reduction in local inflammatory activation (2).

In Part 1 of the presentation Dr. Toutouzas reviews the diagnostic tools used to evaluate features of vulnerable atherosclerotic plaques, and in Part 2 he presents the results of a study investigating thermal heterogeneity in non-culprit lesions, and the effect of statins on plaque temperature of non-culprit lesions.

In the present study, patients with stable angina or acute coronary syndromes were included, who had at least two angiographically significant lesions at different vessels. Culprit lesions were identified in all patients. Thermal heterogeneity was observed in non-culprit lesions to a similar degree as in culprit lesions (3), and statin treatment was found to also be associated with decreased thermal heterogeneity in non-culprit lesions.

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After viewing this presentation the participant will be able to discuss:

- Diagnostic tools for evaluating features of vulnerable plaques
- Evidence for thermal heterogeneity in non-culprit lesions
- Effects of statin treatment on thermal heterogeneity in culprit and non-culprit lesions

1. Steven E. Nissen, M.D., E. Murat Tuzcu, M.D., Paul Schoenhagen, M.D., Tim Crowe, B.S., William J. Sasiela, Ph.D., John Tsai, M.D., John Orazem, Ph.D., Raymond D. Magorien, M.D., Charles O'Shaughnessy, M.D., Peter Ganz, M.D., for the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Investigators Statin Therapy, LDL Cholesterol, C-Reactive Protein, and Coronary Artery Disease N Engl J Med. 2005 Jan 6;352(1):29-38.

2. Stefanadis C, Toutouzas K, Vavuranakis M, Tsiamis E, Tousoulis D, Panagiotakos DB, Vaina S, Pitsavos C, Toutouzas P.
Statin treatment is associated with reduced thermal heterogeneity in human atherosclerotic plaques Eur Heart J. 2002 Nov;23(21):1664-9.

3. Toutouzas K, Drakopoulou M, Mitropoulos J, Tsiamis E, Vaina S, Vavuranakis M, Markou V, Bosinakou E, Stefanadis C. Elevated Plaque Temperature in Non-Culprit De Novo Atheromatous Lesions of Patients With Acute Coronary Syndromes J Am Coll Cardiol. 2006 Jan 17;47(2):301-6.