Effects of Statins on the Epicardial Fat Thickness in Patients with Coronary Artery Stenosis Underwent Percutaneous Coronary Intervention: Comparison of Atorvastatin with Simvastatin/Ezetimibe

Background: Epicardial fat is a visceral thoracic fat and known to be related with presence of dyslipidemia and coronary arterial stenosis. We evaluated the effects and differences of statins on epicardial fat thickness (EFT) in patients underwent successful percutaneous coronary intervention (PCI). Methods: In this retrospective cohort study, we enrolled consecutive patients underwent successful PCI and scheduled six to eight-months follow-up coronary angiography from March 2007 to June 2009. EFT was measured by echocardiography twice at the time of PCI and the follow-up coronary angiography. We included 145 patients (58 females; mean, 63.5 ${\pm}$ 9.5 years). Results: Of the 145 patients, 82 received 20 mg of atorvastatin (atorvastatin group) and 63 medicated with 10 mg of simvastatin with 10 mg of ezetimibe (simvastatin/ezetimibe group). With statin treatments, total cholesterol concentration (189.1 ${\pm}$ 36.1 to 143.3 ${\pm}$ 36.5 mg/dL, p < 0.001), triglycerides (143.5 ${\pm}$ 65.5 to 124.9 ${\pm}$ 63.1 mg/dL, p = 0.005), low density lipoprotein-cholesterol (117.4 ${\pm}$ 32.5 to 76.8 ${\pm}$ 30.9 mg/dL, p < 0.001) and EFT (4.08 ${\pm}$ 1.37 to 3.76 ${\pm}$ 1.29 mm, p < 0.001) were significantly decreased. Atorvastatin and simvastatin/ezetimibe showed similar improvements in the cholesterol profiles. However, atorvastatin decreased EFT more significantly than simvastatin/ezetimibe (EFT change 0.47 ${\pm}$ 0.65 in the atorvastatin vs. 0.12 ${\pm}$ 0.52 mm in the simvastatin/ezetimibe group; p = 0.001). Conclusion: In this study, the atorvastatin group showed significant reduction in EFT than in the simvastatin/ezetimibe group. This might be originated from the statin difference. More large, randomized study will be needed to evaluate this statin difference.