Intensive Lipid-lowering Therapy Ameliorates Novel Calcification Markers and GSM Score in Patients with Carotid Stenosis

Objectives/DesignCarotid plaque echogenicity quantified by the Gray-Scale Median (GSM) score has been associated with plaque vulnerability. The aim of this study was to assess whether intensive lipid-lowering treatment with atorvastatin in patients with carotid artery stenosis ameliorates novel vascular calcification inhibitors, such as osteopontin (OPN) and osteoprotegerin (OPG), and improves GSM score.MethodsNinety-seven patients with carotid stenosis (>40%), but without indication for intervention, were treated for 6 months with atorvastatin (10 mg–80 mg) to target LDL < 100 mg/dl. Fifty-two age-and sex-matched healthy individuals served as the control group. Blood samples and GSM were obtained at the beginning and after 6 months.ResultsSystolic blood pressure, hsCRP, fibrinogen, OPN and OPG levels differed significantly between patients with carotid stenosis and healthy controls at baseline (p < 0.05). Atorvastatin treatment improved lipid profile and significantly reduced hsCRP (p = 0.002), WBC count (p = 0.041), OPN (p < 0.001) and OPG levels (p < 0.001). GSM score increased considerably after atorvastatin therapy (from 58.33 ± 24.38 to 79.33 ± 22.3; p < 0.001) and that effect appeared related to OPN (p = 0.001), OPG (p = 0.013) and LDL (p = 0.01) reduction.ConclusionsIn patients with carotid stenosis, intensive lipid-lowering therapy with statins attenuates serum OPN and OPG levels and enhances carotid plaque echogenicity, outlining their beneficial effects on plaque stability.