Despite the reduction in cholesterol (CH) levels, the modification of carotid intima–media thickness (CIMT) is not evident in all the patients treated with statins. Activities other than CH reduction may determine the improvement in CIMT.

Twenty-two patients with hypercholesterolemia (aged 45-60; males) with CIMT increase started the treatment with atorvastatin. The CIMT (via echography), CH level, and the oxidative balance (OB) were measured at baseline and after 4 weeks. The OB consisted of the determination of the plasmatic hydroperoxides (reactive oxygen metabolites [d-ROMs] test) and the antioxidant reserve (plasma antioxidants test [PAT]). The d-ROMs/CH and PAT/CH ratios allowed to measure, respectively, the oxidative index (OI) and the protective index (PI). The OI/PI ratio represented the OB Risk Index (OBRI) to be compared with the CIMT modifications.

An average reduction of 22% in CH was achieved in the group of patients together with an increase in both OI and PI (16% and 39% respectively) with a significant improvement in OBRI from 2.6 to 1.7 (analysis of variance P < .01). A reduction of >20% in CIMT was obtained in 10 patients whereas in the 12 patients no modification of CIMT was detected, despite the same CH reduction (–55 ± 24.8 and –66 ± 27.1 mg/dL respectively; P > .05). Only those patients with a decrease in OBRI ≥0.8 showed a reduction in CIMT >20%.

In this preliminary study, a significant modification in CIMT was obtained with atorvastatin treatment only in those patients showing an improvement in the OB (OBRI > 0.8).