1. Stains have demonstrated consistent benefits to reduce cardiovascular events in several primary and secondary prevention trials. The suppression of plaque progression or regression may be a part of mechanism of clinical benefit. The intravascular ultrasound studies demonstrated that intensive statin therapy can regress or inhibit the progression of coronary atherosclerosis. 2. Unregulated renin-angiotensin system is important in the pathogenesis of cardiovascular disease. Angiotensin receptor antagonists (ARB) have been reported to improve clinical outcomes in patients with heart failure, left ventricular dysfunction, myocardial infarction, and high-risk patients. Several small studies showed that ARBs were effective to inhibit the progression of coronary atherosclerosis by intravascular ultrasound examination. 3. The combined therapy with statins and ARBs may be additive or synergistic effects on the atherosclerosis regression as well as to improve endothelial dysfunction and insulin resistance in addition to lowering cholesterol levels and blood pressure when compared with either monotherapy in patients. 4. Serial computed tomography angiography (CTA) can be utilized to assess the effect of treatment on coronary plaque morphology. In addition to the assessment of luminal stenosis, CTA also allows characterization of plaque morphology.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
504
Cardiac and Vascular Center; Samsung Medical Center
Seoul, South Korea
PAV(nominal change of percent atheroma volume) in the proximal to mid segments of major epicardial coronary arteries
Left main, LAD proximal to mid (from ostium to a large second diagonal branch), LCX proximal (from ostium to a large first obtuse marginal branch), RCA (from ostium to a distal bifurcation)
Time frame: Over the 48weeks
TAV (nominal change of total atheroma volume) in the proximal to mid segments of major epicardial coronary arteries
Left main, LAD proximal to mid (from ostium to a large second diagonal branch), LCX proximal (from ostium to a large first obtuse marginal branch), RCA (from ostium to a distal bifurcation)
Time frame: Over the 48weeks
LAPV (nominal change of percent low attenuation plaque volume)
Time frame: Over the 48weeks
Nominal change of atheroma volume in 10 mm subsegment with greatest disease severity
Time frame: Over the 48weeks
Change in insulin resistance
Time frame: Over the 48weeks
Major adverse cardiac events
Time frame: Over the 48weeks
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