Differential Associations of Statin and Fibrate Treatment With Carotid Arterial Remodeling

Background The effects of statins on intima-media thickness (IMT) are well documented, whereas those of fibrates are unknown. Therefore we compared IMT under treatment with each class of drugs. Methods We studied a cohort of consecutive dyslipidemic subjects treated with statin (n = 291) or fibrate (n = 82) drugs. Fibrate-treated subjects were matched with the same number of statin-treated subjects to obtain two subgroups of similar demographic and risk factors including LDL cholesterol. Common carotid far wall IMT and lumen diameter were measured by ultrasonography. Results In the entire study population, IMT was greater in the fibrate group than in the statin group (P< .001), even after adjustment for LDL cholesterol and other covariates (P< .05). In the matched groups, IMT was greater in fibrate group than in the statin group (P< .01), even after adjustment for LDL cholesterol and other covariates including treatment duration (P< .01). The IMT correlated positively with treatment duration in the fibrate group (P< 0.05) but not in the statin group. In addition, IMT correlated positively with carotid lumen diameter in both the fibrate and statin groups (P< .05, P< .01) but with a lower slope in the former (P< .05). Conclusions In this study fibrate treatment was associated with greater IMT, steeper IMT–time relationship, and lower compensatory carotid enlargement than was statin treatment. These differences were not explained by differences in LDL cholesterol.