Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic coarctation?

•Statins did not reduce CIMT despite a reduction in total- and LDL cholesterol.•Hypertensive CoA patients demonstrate the highest CIMT and CIMT progression.•Blood pressure control is of major importance to prevent vascular wall damage.•Hypertensive CoA patients demonstrate the highest CIMT and CIMT progression.

BackgroundCarotid intima-media thickness (CIMT) is a marker for atherosclerosis. Adult post-coarctectomy patients (CoA) demonstrate an increased cardiovascular risk and increased CIMT compared to controls. This study evaluates the effect of high dose statins on the change in CIMT and cardiovascular risk.MethodsWe designed a multicenter, prospective, randomized, open label trial with blinded endpoint (PROBE design) to evaluate the effect of three year treatment with atorvastatin 80 mg on CIMT and cardiovascular risk. Primary endpoint was CIMT measured by B mode ultrasonography. Secondary endpoints were mortality and morbidity due to cardiovascular disease and serum lipids.Results155 patients (36.3 ± 11.8 years, 96 (62%) male) were randomized (atorvastatin = 80, no treatment = 75). There was no significant effect of atorvastatin on the change in CIMT (treatment effect − 0.005, 95% CI, − 0.039-0.029; P = 0.76). A significant effect on serum cholesterol and LDL levels was found (− 0.71, 95% CI, − 1.16 to − 0.26; P = 0.002 vs − 0.66, 95% CI − 1.06 to − 0.26; P = 0.001). There was no difference in secondary outcome measures. Baseline CIMT was higher in hypertensive compared to normotensive CoA. (0.69 ± 0.16 mm vs 0.61 ± 0.98 mm; P = 0.002). Hypertension (ß = 0.043, P = 0.031) was the strongest determinant CIMT.ConclusionThree year treatment with atorvastatin does not lead to a reduction of CIMT and secondary outcome measures, despite a decrease in total cholesterol and LDL levels. Hypertensive CoA demonstrate the highest CIMT and the largest CIMT progression. Blood pressure control should be the main focus in CoA to decrease cardiovascular risk.