Early Differential Changes in Coronary Plaque Composition According to Plaque Stability Following Statin Initiation in Acute Coronary Syndrome: Classification and Analysis by Intravascular Ultrasound-Virtual Histology

PURPOSE: The aim of this study was to demonstrate the early effects of statin treatment on plaque composition according to plaque stability on Intravascular Ultrasound-Virtual Histology at 6 months after a coronary event. Previous trials have demonstrated that lipid lowering therapy with statins decreases plaque volume and increases plaque echogenicity in patients with coronary artery disease. MATERIALS AND METHODS: Fifty-four patients (54 lesions) with acute coronary syndrome were prospectively enrolled. We classified and analyzed the target plaques into two types according to plaque stability: thin-cap fibroatheroma (TCFA, n=14) and non-TCFA (n=40). The primary end point was change in percent necrotic core in the 10-mm subsegment with the most disease. RESULTS: After 6 months of statin therapy, no change was demonstrated in the mean percentage of necrotic core (18.7+/-8.5% to 20.0+/-11.0%, p=0.38). There was a significant reduction in necrotic core percentage in patients with TCFA (21.3+/-7.2% to 14.4+/-8.9%, p=0.017), but not in patients with non-TCFA. Moreover, change in percent necrotic core was significantly correlated with change in high-sensitivity C-reactive protein levels (r=0.4, p=0.003). Changes in low-density lipoprotein cholesterol levels and lipid core percentage demonstrated no significant associations. CONCLUSION: A clear reduction of lipid core was observed only for the TCFA plaque type, suggesting that changes in plaque composition following statin therapy might occur earlier in vulnerable plaque than in stable plaque; the effect may be related to the anti-inflammatory effects of statins.

Frequency and Pattern of Hemoglobin Cycling in Korean Hemodialysis Patients Treated with Erythropoiesis Stimulating Agent / 대한신장학회지

PURPOSE: It is frequently observed that the level of hemoglobin (Hb) widely fluctuates during treatment of erythropoiesis stimulating agents (ESAs) in hemodialysis (HD) patients, known as Hb cycling. The purpose of this study was to describe the frequencies and the characteristics of Hb cycling in Korean HD patients treated with ESA. METHODS: Data were analyzed for 49 patients on maintenance HD at our unit between August, 2005 and July, 2006. The patients treated with ESA and oral iron > or =6 months before study period were eligible. Only Hb cycles of duration > or =8 weeks and amplitude >1.5 g/dL were included in the analysis. RESULTS: Forty-seven of patients (96%) had experienced Hb cycling. The mean number of Hb excursions (a half of Hb cycle) was 2.5+/-1.3 times/year/person. The mean amplitude and duration of Hb excursions was 2.4+/-0.7 g/dL and 10.0+/-4.2 weeks, respectively. The mean nadir Hb level of excursions was 9.2+/-0.8 g/dL which was quite lower than 10 g/dL, the lower limit of Hb range recommended in Korea. Down Hb excursions were associated with ESA withdrawal in 78.3%. Patients who were frequent cyclers (> or =2 times/year/person) significantly had a higher prevalence of diabetes mellitus than others (57.1% vs. 28.6%, p=0.047). CONCLUSION: Hb cycling is a common and a serious feature in HD patients treated with ESA. It is primarily a result of anemia treatment practices, especially holding of ESA and, in part, underlying diabetes.