NEW YORK (Reuters Health) – The results of a study using a special MRI technique suggest that treatment with high-dose atorvastatin can reduce inflammation in carotid artery plaques, which may help prevent rupture and, therefore, stroke.

Dr. Jonathan H. Gillard, from Cambridge University, UK, and colleagues note in the Journal of the American College of Cardiology for June 2 that ultrasmall superparamagnetic iron oxide (USPIO)-enhanced MRI has been shown to identify macrophage infiltration in carotid plaques, which may be used as a marker for inflammation.

In recent studies, statin therapy has been shown to reduce inflammation. However, until now, the only noninvasive evidence that these agents could cut plaque inflammation in clinical practice has come from studies using PET imaging. Because of the radiation exposure, PET imaging is limited in the number of times it can be used on a given subject and, thus, it is not an ideal means of assessing inflammation before and after treatment.

The ATHEROMA (Atorvastatin Therapy: Effects on Reduction of Macrophage Activity) study involved 47 patients with carotid stenosis >40% who had plaque inflammation on baseline USPIO-enhanced MRI. The subjects were randomized to receive atorvastatin 10 mg or 80 mg daily for 12 weeks.

MRI signal intensity from carotid plaque increased over time if inflammation was reduced. Plaque inflammation decreased significantly in the 80-mg group, with changes in signal intensity of 0.13 at 6 weeks (p = 0.0003) and 0.20 at 12 weeks (p < 0.0001). No significant change was noted in the 10-mg group. Use of the higher dose also cut total cholesterol by 15% and LDL cholesterol by 29%. In accompanying editorial, Dr. Zahi A. Fayad, from Mount Sinai School of Medicine, New York, and colleagues comment that “although the current statin trial using noninvasive carotid USPIO-MRI is interesting and unique, further studies are required to determine the clinical applicability of this methodology for use as an end point in clinical trials.” Reference:
J Am Coll Cardiol 2009.