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Atorvastatina ed etidronato riducono il rischio di placche aortiche

E' documentato che le statine sono in grado di ridurre le placche aterosclerotiche di carotidi, coronarie e aorta toracica, ma sembrano avere uno scarso effetto su quelle dell'aorta addominale. La spiegazione potrebbe essere nella diversa composizione delle placche che nell'aorta addominale sono più spesso fibrose e calcificate, mentre in quella toracica prevalgono quelle più ricche in colesterolo che sono più suscettibili di modifica in seguito alla terapia con statine. Associando alla statina un bifosfonato come l'etidronato, ad azione specifica sui depositi di calcio, si potrebbero ottenere benefici anche per le placche calcifiche dell'aorta addominale. Del resto, alcuni studi sperimentali, avevano già dimostrato che il bifosfonato di per sé potesse indurre regressione delle placche aterosclerotiche e delle calcificazioni vascolari. Combinando l'azione dell'etidronato sul calcio e dell'atorvastatina sul colesterolo, si è in effetti ottenuta una significativa regressione anche delle placche dell'aorta addominale in pazienti con ipercolesterolemia.

Atorvastatin, etidronate, or both in patients at high risk for atherosclerotic aortic plaques: a randomized, controlled trial

Kawahara T, Nishikawa M, Kawahara C, Inazu T, Sakai K, Suzuki G

Circulation 2013;127:2327-2335

BACKGROUND: Statins are not effective in reducing atherosclerotic plaques of the abdominal aorta, and accumulating evidence suggests that bisphosphonates have the potential to induce the regression of atherosclerotic plaques of the abdominal aorta.
METHODS AND RESULTS: A prospective, randomized, open-label, blinded-end-point trial involving 108 participants with hypercholesterolemia was conducted. Participants received 20 mg atorvastatin daily, 400 mg etidronate daily, or both drugs daily. The primary end point was the percent change in maximal vessel wall thickness of atherosclerotic plaques in the thoracic and abdominal aortas as measured by magnetic resonance imaging after 12 months of treatment. In both the combination therapy and atorvastatin groups, maximal vessel wall thickness of the thoracic aorta was reduced by 13.8% (95% confidence interval, -16.4 to -11.3) and 12.3% (95% confidence interval, -14.9 to -9.7), respectively. These reduction rates were comparable between groups (P=0.61). Meanwhile, in the etidronate group, maximal vessel wall thickness of the thoracic aorta remained unchanged (2.2%; 95% confidence interval, -0.3 to 4.8). Conversely, maximal vessel wall thickness of the abdominal aorta was reduced more effectively in the combination therapy group (-11.4%) than in the atorvastatin group (-0.9%; P<0.001) and the etidronate group (5.5%; P=0.006).
CONCLUSIONS: Atorvastatin plus etidronate combination therapy for 12 months significantly reduced both thoracic and abdominal aortic plaques, whereas atorvastatin monotherapy reduced only thoracic aortic plaques and etidronate monotherapy reduced only abdominal aortic plaques. The effectiveness of combination therapy in reducing atherosclerotic plaques in the abdominal aorta was significantly greater than for both atorvastatin and etidronate monotherapy.

Circulation 2013;127:2327-2335