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￭ S-173 ￭
CIMT compared to Cardiac CT Ca score for estimating atherosclerosis in young fatty liver patient
Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Korea
*Incheol Yoon, Hyun-Jin Kim, Hyung-Bok Park, Yongsung Suh, Yoon-Hyeong Cho, Tae-Young Choi, Eui-Seok Hwang, Deok-Kyu Cho
Background: As a surrogate of atherosclerosis, carotid intima-media thickness (IMT) and coronary artery calcium score (CACS) of over 100 by Cardiac CT scan can predict cardiovascular events. Fatty liver disease as a potential component of the metabolic syndrome is also linked to car- diovascular disease. This study evaluated the differences of the carotid IMT and the CACS in patients with fatty liver disease. Methods: The patients who had performed carotid, abdomen ultrasound and cardiac CT were evaluated retrospectively between Jun 2011 and December 2013. The primary outcome was the difference of the carotid IMT and the CACS between the fatty liver disease patients and patients with normal liver. Results: Among 819 patients (53.3 ±11.2 year), 330 patients had fatty liver disease. Patients with fatty liver disease had significant larger waist circumferences and body mass index. The incidences of hypertension, diabetes, and the dyslipidemia were also higher in patient with fatty liver disease. Furthermore, the carotid IMT was significantly thicker in patients with fatty liver disease than the patients with normal liver (0.79 ± 0.17 mm vs. 0.76 ±0.17 mm, p＝0.012), and carotid plaque showed the more common tendency in patient with fatty liver disease (26.7% vs. 21.7%, p＝0.099). The incidences of composite of the thick carotid IMT (≥75th percentile) and the plaque presence were significantly higher in fatty liver (43.0% vs. 36.0%, p＝0.043). Especially patients under fifty years old, the carotid IMT was significantly thicker in patient with fatty liver than normal liver. Fatty liver disease increased the risk of the composite of the thick carotid IMT and the plaque in young patient (OR 1.83, 95% CI 1.00-3.34, p＝0.05). However, the incidences of CACS of over 100 showed no significant difference between two groups. Conclusions: Carotid IMT reflect the worse baseline characteristics of the patients with fat- ty liver diseases than the CACS. Especially, fatty liver disease increase the risk of atherosclerosis in young patients under 50. Therefore, young patients with fatty liver disease need to perform screening IMT for detecting atherosclerosis and modifying the risk factors.
￭ S-174 ￭
Antiplatelet activity and clinical outcomes on CYP3A4-metabolized statin in PCI
Department of Cardiology, Pusan National University Hospital, Busan, Korea
*Eun Heui Kim, Jin Sup Park
Purpose: Statins primarily metabolized by cytochrome P450 3A4 (CYP3A4) reportedly reduce clopidogrel metabolism to active metabolite. Recent studies suggest that CYP 3A4-metabolized statins attenuate the anti-aggregatory effect of clopidogrel. We sought to assess the antiplatelet activity of a CYP 3A4 metabolized statin and its association with clinical outcomes duringdual antiplatelet therapy following percutaneous coronary intervention (PCI). Methods: Among 3,755 patients enrolled the HOST-ASSURE trial, 1,187 patients with both baseline and 1-month platelet reactivity unit (PRU) values assessed by VerifyNow P2Y12 assay were assigned to the CYP 3A4-metabolized statin group (n＝725) or non-CYP 3A4-metabolized statin group (n＝462) according to type of statins used. The co-primary outcome were the differences between baseline and 1-month follow-up of PRU value and the composite of cardiovascular death, recurrent MI, including stent thrombosis, any revascularization and cerebrovascular accident (CVA) during the follow-up period. We compared the outcomes between groups both in the propensity adjusted and matched cohorts. Results: Mean difference of PRU values was not significant in the CYP 3A4-metabolized statin group (mean difference: -4±84, p＝0.367) and was significant in the non-CYP 3A4-metabolized statin group (mean difference: -12±69, p＝0.006) both in the propensity scoreadjusted and matched cohorts. Patients with high PRU value at baseline, irrespective of the type of used statins, were associated with a significant reduction in mean difference of PRU values both in the pro- pensity score adjusted (mean difference: -53.35, p＜0.001) and matched cohort (mean difference: -41.57, p＜0.001). The composite of clinical events did not differ between groups both in the propensity score adjusted (hazard ratio [HR] 0.962, 95% confidence interval [CI] 0.621-1.489, p＝0.861) and matched (HR 0.902, 95% CI 0.554-1.468, p＝0.678) cohorts. Conclusions: This study showed that a CYP 3A4-metabolized statin slightly reduces an- tiplatelet activity of clopidogrel during dual antiplatelet therapy but did not increase clinical events in patients following PCI.
