CAROTID DOPPLER STUDIES IN PATIENTS WHO ONLY FAILED ENROLLMENT IN THE JUPITER TRIAL DUE TO A LOW hsCRP
MF Matangi, DW Armstrong, M Nault, D Brouillard
We have previously presented data at the CCC indicating that 27 of 28 of patients that we enrolled in the JUPITER trial had an abnormal carotid duplex imaging studies. In fact, 25 of the 28 (89.3%) had ICA stenoses using ICAVL imaging and velocity criteria. The purpose of our current investigation was to look at the CCA IMT in our patients who failed enrollment in the JUPITER trial, specifically those patients with a normal LDL cholesterol (<3.4mmol/l) and normal hsCRP (<2.00mmol/l.
METHODS and RESULTS
Our JUPITER screening log was searched for patients who failed enrollment in the trial due to a normal LDL Cholesterol and a normal hsCRP. There were 21 patients identified. All patients then underwent carotid duplex imaging for mesurement of common carotid artery intimal medial thickness, (CCA IMT). CCA IMT was measured manually in the far wall of the common carotid artery. Any degree of internal carotid artery (ICA) stenosis was classified according to ICAVL imaging and velocity criteria.
RESULTS: There were 16 males and 5 females with a mean age of 69.0 ± 5.6 years. Of the 21 patients 19 (90.5%) had an abnormal carotid study. 3 Patients had only an increased CCA IMT (>1.0mm) without any ICA stenosis, [mean R) cIMT 1.10mm, L) 1.20mm]. 16 patients had an ICA stenosis, 7 with 1-39% ICA stenoses bilaterally, 8 with one ICA with a 1-39% stenosis and 1 patient with an ICA stenosis of 40-59% on the R) and a 1-39% stenosis on the L).
Our JUPITER study enrollment failures with low LDL cholesterol and normal hsCRP have significant carotid disease. 19 of 21 patients had carotid disease (90.5%), 16 of which (76.2%) had an internal carotid artery stenosis by ICAVL imaging and velocity criteria. These JUPITER enrollment failures were on average slightly older. The median age in JUPITER was 66 years and the interquartile range 60-71 years. Our enrollment failures averaged 69.0 years. It seems to us that the JUPITER trial may well be a trial of lipid lowering in the elderly with normal LDL cholesterols. The very high prevalence of carotid disease in males >50yrs and females >60yrs may be the reason why the JUPITER trial was such a successful trial?