Rosuvastatin combined with ramipril significantly reduced atheroma volume by anti-inflammatory mechanism: Comparative analysis with rosuvastatin alone by intravascular ultrasound

Abstract Background We tested the effects of rosuvastatin combined with ramipril on atheroma volume and its mechanism in de novo, intermediate coronary artery disease. Methods Subjects were randomly assigned to 2 treatment groups (rosuvastatin alone group; 20 mg/day, combined group; rosuvastatin 20 mg/day and ramipril 10 mg/day). Total atheroma volume per 10 mm segment (TAV/10 mm), percent atheroma volume per 10 mm segment (PAV/10 mm) in entire indexed segments and TAVmost10 , PAVmost10 in a 10 mm subsegment with the greatest disease by intravascular ultrasound, and lipids, metabolic parameters (adiponectin, insulin sensitivity), biomarkers (hsCRP, matrix metalloproteinase-9) were analyzed at baseline and at 9–12 months follow-up. Results A total of 40 patients (rosuvastatin group; 21, combined group; 19), 46 lesions (rosuvastatin group; 24, combined group; 22) were finally analyzed. Rosuvastatin alone significantly reduced TAV/10 mm (− 7.8 ± 17.4%, p < 0.001) but did not change PAV/10 mm, TAVmost10 , PAVmost10 after therapy. In combined group, TAV/10 mm, TAVmost10 , PAVmost10 were significantly reduced after therapy (− 10.7 ± 11.5%, − 13.4 ± 14.5%, − 2.7 ± 5.8%, p < 0.001, < 0.001 and p = 0.04) but PAV/10 mm did not change. The magnitude of changes of all IVUS derived parameters did not differ significantly between 2 groups. Of interest, the most important factor for the changes of PAVmost10 was the percent changes of LDL cholesterol (β = 0.23, 95% CI [0.07–0.39], p = 0.007) in rosuvastatin alone group and the changes in hsCRP (β = 1.89, 95% CI [0.63–3.14], p = 0.005) and baseline fasting blood glucose (β = 0.06, 95% CI [0.01–0.11], p = 0.02) in combined group by multivariate analysis. Conclusions Rosuvastatin combined ramipril therapy significantly reduced atheroma volume that was related with anti-inflammatory effects.