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Aging and disease    2019, Vol. 10 Issue (2) : 258-266     DOI: 10.14336/AD.2018.0526
Original Article |
Intensive Lipid-Lowering Therapy Ameliorates Asymptomatic Intracranial Atherosclerosis
Huijuan Miao1, Yujiao Yang2, Han Wang3, Linyu Huo4, Mengnan Wang1, Yinghua Zhou5, Yang Hua5, Ming Ren1, Changhong Ren6, Xunming Ji7, Qi Yang8, Xiuhai Guo1,*
1Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
2Department of Neurology, Sanbo Brain Hospital, Beijing, China
3Department of Neurology, Huimin Hospital, Beijing, China
4Department of Neurology, Haidian Hospital, Beijing, China
5Department of Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
6Laboratory of Hypoxia, Xuanwu Hospital, Capital Medical University, Beijing, China
7Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
8Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
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Abstract  

Statins have proven to exert protective effects in patients with symptomatic intracranial atherosclerotic stenosis (SICAS). It is unclear whether intensive lipid-lowering therapy (ILLT) can ameliorate atherosclerosis in asymptomatic ICAS (AICAS). A single-center, prospective cohort study was performed in 71 AICAS patients with lipid-lowering therapy. Vascular stenoses were evaluated with transcranial color-coded sonography (TCCS) before and after statin treatment. With target therapeutic level of low-density lipoprotein cholesterol (LDL-C) ≤ 1.8 mmol/L or ≥ 50% reduction from baseline after the two years of follow-up, patients were divided into intensive statin treatment (IST) group and standard statin treatment (SST) group. A total of 104 stenotic intracranial arteries were detected in 51 patients belonging to the IST group and 47 arteries in 20 patients of the SST group. In the first year, LDL-C levels were significantly decreased in the IST compared with SST groups (1.48 ± 0.26 vs. 2.20 ± 0.58, P=0.000). However, the ratio of regressed ICAS in IST was not significantly higher than that in SST (26.3% vs. 5.9%, P=0.052). Forty-nine branches in 25 patients of the IST group and 16 branches in 7 patients of the SST group were followed up for two years. The LDL-C level was decreased in the IST compared with SST groups (1.55 ± 0.29 vs. 2.36 ± 0.77, P=0.048). The ratio of regressed ICAS in the IST group was significantly higher than that in SST group (34.7% vs. 6.3%, P=0.017). We concluded that the degree of stenosis in AICAS can be ameliorated with intensive lipid-lowering therapy within two years; target LDL-C level can be reached by moderate-intensity statin treatment for Chinese AICAS patients.

Keywords intracranial atherosclerosis      asymptomatic      transcranial color-coded sonography      lipid-lowering therapy     
Corresponding Authors: Guo Xiuhai   
About author:

These authors contributed equally to this work.

Issue Date: 10 March 2018
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Huijuan Miao
Yujiao Yang
Han Wang
Linyu Huo
Mengnan Wang
Yinghua Zhou
Yang Hua
Ming Ren
Changhong Ren
Xunming Ji
Qi Yang
Xiuhai Guo
Cite this article:   
Huijuan Miao,Yujiao Yang,Han Wang, et al. Intensive Lipid-Lowering Therapy Ameliorates Asymptomatic Intracranial Atherosclerosis[J]. Aging and disease, 2019, 10(2): 258-266.
URL:  
http://www.aginganddisease.org/EN/10.14336/AD.2018.0526     OR     http://www.aginganddisease.org/EN/Y2019/V10/I2/258
Figure 1.  Patients and vessel selection. TCCS: transcranial color-coded sonography; LDL-C: low-density lipoprotein cholesterol.
IST (n=51)SST (n=20)p Value
Age (years)59.96 ± 9.67960.20 ± 9.7150.926
Male (%)24 (47.1%)12 (60%)0.237
BMI (kg/m2)23.71 ± 6.4724.48 ± 4.070.574
Smoking (%)17 (33.3%)9 (45%)0.258
Drinking (%)12 (23.5%)4 (20%)0.509
Hypertension (%)36 (70.6%)14 (70%)0.588
Diabetes mellitus (%)14 (27.5%)4 (20%)0.373
Hyperlipidemia (%)37 (72.5%)17 (85%)0.216
Hyperhomocysteinemia (%)7 (17.1%)6 (30%)0.203
Coronary heart disease (%)11(21.6%)00.019
Initial lipid level (mmol/L)
  LDL-C2.51 ± 1.002.63 ± 0.590.560
  HDL-C1.38 ± 0.301.38 ± 0.350.979
  NLDL-C2.68 ± 1.012.99 ± 0.990.425
Statin level (mg/day)10.20 ± 0.9810.25 ± 1.120.840
Mean stenotic vessels2.04 ± 1.252.35 ± 1.630.571
Table 1  Baseline characteristics of IST and SST group.
IST (104)SST (47)p Value
Location of stenosis, n (%)0.106
  Anterior cerebral artery11 (10.6%)11 (23.4%)
  Middle cerebral artery61 (58.7%)18 (38.3%)
Terminal ICA12 (11.5%)9 (19.1%)
  Basilar artery10 (9.6%)5 (10.6%)
  Posterior cerebral artery10 (9.6%)4 (8.5%)
Degree of stenosis, n (%)0.481
  Mild58 (55.8%)23 (48.9%)
  Moderate30 (28.8%)13 (27.7%)
  Severe16 (15.4%)11 (23.4%)
Table 2  Location and severity of AICAS (baseline TCCS results).
ISTSSTp Value
p Value0.0000.154
Initial2.51 ± 1.002.63 ± 0.590.560
First year1.48 ± 0.262.20 ± 0.580.000
Second year1.55 ± 0.292.36 ± 0.770.048
Table 3  LDL-C levels at different follow-up years.
First year
Second year
RegressedStableProgressedp ValueRegressedStableProgressedp Value
0.1060.091
IST (n)2562817248
SST (n)23111123
Table 4  Changes in stenoses between IST and SST in the first and second year of follow-up.
Figure 2.  A 33-year-old man with asymptomatic intracranial atherosclerosis (AICAS) in the intensive statin treatment group (IST). A and B) TCCS at one-year follow-up showed a peak systolic velocity (PSV) of 258 cm/s for the right proximal middle cerebral artery (MCA), which indicated severe stenosis (arrow). C and D) after two years of lipid-lowering treatment of Rosuvastatin (10 mg/day), follow-up TCCS showed an obvious reduction of PSV to 195 cm/s, indicating moderate stenosis (arrow).
Figure 3.  Follow-up results of stenotic vessels in the IST and SST groups in the first and second year. The regression rate in the IST group was significantly higher than that in the SST group (*p=0.017).
IST
SST
RegressedStableProgressedTotalp ValueRegressedStableProgressedTotalP Value
0.9980.777
1st YearMild (n)1332449115117
Moderate (n)82033119010
Severe (n)4101150707
0.4540.031
2nd YearMild (n)7952109110
Moderate (n)783180224
Severe (n)370101102
Table 5  The changes of different stenotic levels in the first and second year of follow-up.
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