Advance of statins and reverse of coronary artery atheromatous plaque

In recent years,intravascular ultrasound（IVUS） follow-up is always used in the evaluation of the development of atherosclerosis,and it can also be used as the endpoint of drug therapy in clinical observation.Since 1994,the first statin lipid-lowering 4S experiment results was reported,the following statin for lipid-lowering tests represented by REVERSAL PROVE-IT,TNT,IDEAL,ASTEROID and JUPITER strongly confirmed that further reduce the efficacy of low-density lipoprotein cholesterol（LDL-C）（to enhance the lipid-lowering treatment） access to increase effect of the cardiovascular protection and also reverse the plaques＇ progress.But scholars＇ opinions on the merits and demerits of enhance statin cholesterol-lowering therapy has been in debate.We review the recent work on statins and reversal of arterial plaques for a number of clinical studies.

Effects of pioglitazone on arteriosclerotic-related factors and short term prognosis in patients with coronary disease and diabetes

Background Thiazolidinediones （TZDs） not only improve insulin resistance, lowering blood sugar, also has anti-atherosclerotic effect. However, whether the protective effect on cardiovascular pioglitazone is still controversial. Methods Totally 98 patients with coronary disease and diabetes mellitus were randomly divided into pioglitazone group （n = 48） receiving conventional therapy and pioglitazone （15 mg/day）, and control group （n = 50） merely receiving conventional therapy. The patients were followed up for 12 months. The plasma level of Plasminogen activator Inhibitor 1 （PAI-1） and P-selectin were detected at baseline and after treatment for 12 months by ELISA, and major adverse cardiac events （MACE） were studied. Results Pioglitazone therapy for 12 months was associated with a significant decrease of PAI-1 [（7.9 ± 1.4 vs 4.2 ± 0.5）ng/mL, P 〈 0.05] and P-selectin [（16.6 ± 6.8 vs 12.4 ± 3.6）ng/mL, P 〈 0.05], MACE was significantly lower in the pioglitazone group than in the control group [acute coronary syndrome （ACS）： 32.0% vs 10.4%, P 〈 0.05; target vessel revascularization： 22.0% vs 6.3%, P 〈 0.05 ]. Conclusions Pioglitazone can effectively reduce the plasma level of PAI-1, P-selectin and the occurrence of MACE in patients with coronary heart disease and diabetes mellitus.

Relation between pre-procedural glucose levels and incidence of major adverse cardiac events in chronic kidney disease patients without established diabetes undergoing percutaneous coronary intervention

Background It is well known that there was a significant link between preprocedural blood glucose levels and short-term and long-term adverse outcomes in patients undergoing elective PCI. However, the role of preprocedural blood glucose levels as a predictor of adverse events in CKD patients who underwent PCI out of established diabetes has acute were coronary syndrome yet to be （ACS） identified. Methods In our study, we conducted a prospective study of 331 patients with CKD who underwent PCI out of established diabetes. Patients divided into two groups based on pre-procedural glucose levels （hypoglycemia 〈 7.0 mmol/L; hyperglycemia ≥ 7.0 mmol/L）. All patients were followed up prospectively for major adverse cardiovascular events （MACEs） and mortality for 6 months. Results In our cohort, hyperglycemia patients reported a higher incidence of inhospital mortality than hypoglycemia patients （7.5% vs. 0%, P 〈 0.001）. Hyperglycemia patients reported a significantly higher rate of 6-month MACEs （10% vs. 2.4%, P = 0.007）, all cause mortality （7.5% vs. 1.6%, P = 0.015）, and cardiovascular mortality （6.2%vs 1.6%, P = 0.041） compared with hypoglycemia patients with pre-procedural glucose levels 〈 7.0 mmol/L. Multivariate analysis disclosed that a pre-procedural glucose level ≥7.0 mmol/L was a significant independent predictor of MACEs （OR = 2.53, 95% CI 1.68-17.15, P = 0.004）, all cause mortality（OR = 4.6, 95% CI 1.10-18.84, P = 0.036）, and cardiovascular mortality（OR = 6.2, 95% CI 1.53-24.94, P = 0.011） at 6 months in patients after PCI. Conclusion The study suggested that pre-procedural glucose levels are associated with short-term cardiovascular outcome CKD patients who underwent PCI without established diabetes in the setting of ACS.