The Multicenter Atorvastatin Plaque Stabilization (MAPS) Study
The Multicenter Atorvastatin Plaque Stabilization (MAPS) Study
The impact on cardiovascular events achieved by statin therapy seems to be mostly
 attributable to the cholesterol-lowering effect with a highly debated contribution of the
 lipid-independent pleiotropic effects. However, a short-term benefit has been documented for
 patients treated with statins in acute coronary syndromes and other clinical settings. These
 observations strengthened the hypothesis of additional, so-called pleiotropic actions of
 statins.

 The investigators therefore sought to investigate how different lipid-lowering strategies
 (non-statin therapy, low-dose statin and high-dose statin) affects cellular composition of
 carotid plaque over a short-term period of three months. Specifically the investigators tried
 and dissect the LDL-C lowering impact on plaque cellular composition as compared to the
 lipid-independent contribution on plaque macrophage and smooth muscle cells.
Patients (with Total Cholesterol (TC) ranging between 5.83-7.64 mmol/l), never treated with
 lipid lowering drugs, with symptomatic carotid stenosis >70% (NASCET criteria), and therefore
 eligible for carotid endarterectomy, were recruited. All patients were enrolled within 30
 days from the clinical event, and randomized to one of three treatment groups. Each group,
 composed of 20 patients, received atorvastatin 10 mg/day (AT-10 group), or atorvastatin 80
 mg/day (AT-80 group), or cholestyramine (Questran, Bristol Myer Squibb) 8 g/day plus
 sitosterol (Unilever) 2.5 g/day (C-S group) for three months prior to the vascular procedure.
 A placebo group was not included for ethical reasons due to the high cardiovascular risk
 profile in this population.
Inclusion Criteria:

 -  Symptomatic carotid stenosis > 70% (NASCET criteria)

 -  Eligibility for carotid endarterectomy

 -  Total cholesterol level between 5.83 and 7.64 mmol/L

 -  Never treated with lipid lowering drugs

 Exclusion Criteria:

 -  Previous lipid lowering therapy

 -  Total cholesterol <5.83 or >7.64 mmol/L

 -  Evidence of chronic inflammatory disease (clinical and laboratory).

 -  Patients at high risk for cerebrovascular events (i.e. ulcerated carotid plaque,
 recurrent TIAs).