Lipid-lowering therapy for aortic plaques

A 56-year-old woman had been treated for hypercholester­o­lemia and hypertension at our hospital for 8 years. She had no history of cardiovascular disease, and her blood pressure had been around 140/85 mm Hg on antihypertensive medication (8 mg/day candesartan). Her serum low-density-lipoprotein (LDL)-cholesterol level had been high (usually around 160 mg/dL) on 20 mg/day pravastatin treatment. After informed consent was obtained to participate in our study, pravastatin was discontinued. Four weeks later, her LDL-cholesterol level increased to 196 mg/dL, and magnetic resonance imaging (MRI) indicated atherosclerotic plaques in both the thoracic and abdominal aortas. She was assigned to receive 20 mg/day of atorvastatin.

After 12 months of atorvastatin treatment, her LDL-cholesterol level decreased markedly (to 87 mg/dL, a 56% reduction). Atorvastatin treatment also reduced her plasma high-sensitivity C-reactive protein level from 0.81 mg/L to 0.15 mg/L (an 82% re­duction). Two thoracic and 2 ab­dom­inal aortic plaques of this patient were followed up using MRI, and a regression in the thoracic aortic plaques but not in the abdominal aortic plaques was observed after 12 months of treatment. As shown in the Figure, her thoracic aortic plaques were recognized to have a lipid-rich core, and it showed a regression (8% vessel wall area reduction). On MRI, lipid components were identified as hyperintense on proton density-weighted (PDW) images and as hypointense regions on T2-weighted (T2W) images. This plaque had a hypointense region in its center on the T2W image. The arrows indicate plaques, and the arrowhead indicates a lipid-rich core.

This case report demonstrates a regression of the thoracic aortic plaque with a marked reduction in LDL-cholesterol level after 1 year of 20 mg atorvastatin treatment in a patient with hypercholesterolemia.