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Comparison of High-Dose Rosuvastatin Versus Low-Dose Rosuvastatin Plus Ezetimibe on Carotid Atherosclerotic Plaque Inflammation in Patients with Acute Coronary Syndrome

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Abstract

We compared the effects of ezetimibe/rosuvastatin 10/5 mg versus rosuvastatin 20 mg on carotid atherosclerotic plaque inflammation measured by 18FDG PET/CT. Fifty patients with acute coronary syndrome (ACS) were randomly assigned to the ezetimibe/rosuvastatin 10/5 mg and rosuvastatin 20 mg groups. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS), as assessed by 18FDG PET/CT at baseline and at 6 months. Forty-eight patients completed follow-up PET/CT. MDS TBR was − 6.2 ± 13.9% for patients in the ezetimibe/rosuvastatin group and − 10.8 ± 17.7% for those in the rosuvastatin group (difference, 4.6 percentage points; upper limitation of one-sided confidence interval = 13.8; p = 0.60 for noninferiority). In conclusion, combination therapy with ezetimibe 10 mg and rosuvastatin 5 mg compared with rosuvastatin 20 mg did not meet the criterion for non-inferiority for primary outcome, and the present study was not conclusive on whether the former was non-inferior to the latter.

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Abbreviations

18FDG:

18F-fluorodeoxyglucose

ACEI:

Angiotensinconverting enzyme inhibitor

ACS:

Acute coronary syndrome

ARB:

Angiotensin receptor blocker

ASCVD:

Atherosclerotic cardiovascular disease

CAD:

Coronary artery disease

HDL:

High-density lipoprotein

NSTE-ACS:

Non-ST segment elevation-acute coronary syndrome

PCI:

Percutaneous coronary intervention

LDL:

Low-density lipoprotein

MDS:

Most diseased segment

PET/CT:

Positron emission tomography-computed tomography

STEMI:

ST segment elevation myocardial infarction

SUV:

Standardized uptake value

TBR:

Target-to-background ratio

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Funding

This study was supported by grants from Yuhan Corporation, Seoul, Korea.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Minyoung Oh, Hyunji Kim, Eon Woo Shin, Changhwan Sung, Do-Hoon Kim & Dae Hyuk Moon

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Nayoung Kim

  3. Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, South Korea

    Jae Seon Eo

  4. Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea

    Jin Won Kim

  5. Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Cheol Whan Lee

  6. Division of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea

    Cheol Whan Lee

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  1. Minyoung Oh
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Correspondence to Cheol Whan Lee.

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Conflict of Interest

Minyoung Oh, Hyunji Kim, Eon Woo Shin, Changhwan Sung, Do-Hoon Kim, Dae Hyuk Moon, Nayoung Kim, Jae Seon Eo, Jin Won Kim, and Cheol Whan Lee declare that they have no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Human Subjects/Informed Consent Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the principles of the1964 Declaration of Helsinki and its later amendments. The protocol for this study was approved by the Institutional Review Committee of Asan Medical Center and Korea University Guro Hospital. Written informed consent was obtained from all individual participants included in the study.

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Associate Editor Emanuele Barbato oversaw the review of this article

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Oh, M., Kim, H., Shin, E.W. et al. Comparison of High-Dose Rosuvastatin Versus Low-Dose Rosuvastatin Plus Ezetimibe on Carotid Atherosclerotic Plaque Inflammation in Patients with Acute Coronary Syndrome. J. of Cardiovasc. Trans. Res. 13, 900–907 (2020). https://doi.org/10.1007/s12265-020-10009-4

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