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Circulation, Vol 88, 20-28, Copyright © 1993 by American Heart Association
DH Blankenhorn, RH Selzer, DW Crawford, JD Barth, CR Liu, CH Liu, WJ Mack and P Alaupovic
BACKGROUND. Controlled clinical trials have reported treatment effects
evaluated with serial imaging in coronary and femoral but not cervical
arteries. The Cholesterol Lowering Atherosclerosis Study, a coronary,
cervical, and femoral angiographic trial of colestipol plus niacin,
included a pilot study of standardized carotid ultrasound imaging. METHODS
AND RESULTS. Seventy-eight subjects had ultrasound studies at baseline, 2,
and 4 years. Twenty-four drug and 22 placebo subjects had carotid
ultrasound images at baseline, 2, and 4 years with matching cervical
angiograms. Computer image processing was applied to ultrasound images of
common carotid (far wall) and cervical angiograms. Computer operators were
blind to treatment group. Carotid ultrasound measurements were tested for
treatment effects and compared with measurements of atherosclerosis in
coronary and cervical angiograms. Drug subjects showed significant
progressive reduction in carotid thickness at 2 (P = .0001) and 4 years (P
= .0001); placebo subjects significantly increased wall thickness at 2 and
4 years. Reduced levels of apolipoprotein B and increased levels of high
density lipoprotein cholesterol and apolipoprotein C-III were significant
predictors of carotid wall thinning. Ultrasound-measured carotid
intima-media thickness was correlated at baseline with visually read
coronary angiographic stenosis and at 2 years with a robust computer
measurement of mild carotid atherosclerosis. CONCLUSIONS. Common carotid
intima- media thickening can be reduced by colestipol-niacin treatment.
Two- year image-processed carotid ultrasound trials can provide adequate
power with 50 subjects per group to test for this treatment effect.
ARTICLES
Beneficial effects of colestipol-niacin therapy on the common carotid artery. Two- and four-year reduction of intima-media thickness measured by ultrasound
Department of Medicine, University of Southern California, Los Angeles.
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