Statin Treatment, Carotid Atherosclerotic Plaque Macrophage Infiltration and Circulating Inflammatory Markers

Michael Koutouzis1, Kosmas I Paraskevas*, 2, Loukianos S Rallidis3, Calypso Barbatis4, Alexandros Nomikos4, Vasiliki Tzavara5, Maria Tsopanomichalou4, Christos Lioupis2, Nikolaos Bessias, Vassilios Andikopoulos2, Dimitri P Mikhailidis6, Zenon S Kyriakides1
1 2ndDepartment of Cardiology, Red Cross Hospital, Athens, Greece
2 Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
3 2ndDepartment of Cardiology, Attikon University Hospital, Athens, Greece
4 Department of Histopathology, Red Cross Hospital, Athens, Greece
5 1stDepartment of Internal Medicine, Red Cross Hospital, Athens, Greece
6 Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) and Dept. of Surgery, Royal Free Hospital campus, University College London (UCL), London, UK

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© Koutouzis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Vascular Surgery, Red Cross Hospital, Athens, Greece; E-mail:



Statin treatment is considered as first line therapy in patients with atherosclerotic disease. We evaluated the effect of pre-treatment with statins on carotid plaque infiltration by macrophages and on the circulating levels of proinflammatory cytokines in patients who underwent carotid endarterectomy.

Patients and Methods

One hundred fourteen patients were enrolled; 89 men and 25 women (mean age 67±8 years; range 42-83 years). Fifty three patients (46%) were on statin treatment at least 3 months before endarterectomy and 61 (54%) had never received statin treatment. The serum levels of high sensitivity C reactive protein (hsCRP), serum amyloid A (SAA), tumor necrosis factor α (TNFα), interleukin (IL)-1β and IL-6 were evaluated preoperatively. The intensity of macrophage infiltration was evaluated by immunochemistry, using the monoclonal antibody CD 68. The area of the plaque covered by macrophages was measured as a proportion of the whole plaque area, using a custom designed image tool analysis.


Patients on statins had lower serum total cholesterol levels (172±50 vs 194±35 mg/dl, p= 0.014), lower low density cholesterol levels (103±44 vs 123±31 mg/dl, p= 0.010) and lower serum hsCRP levels (1.8 [1.1-3.4] vs 3.4 [1.3-4.9] mg/l, p= 0.03), while SAA, TNFα, IL-6 and IL-1β levels did not differ between the 2 groups. The infiltration of atherosclerotic plaque by macrophages was similar in statin treated patients and in controls (0.55±0.15% vs 0.49±0.19%, p= 0.21).


Patients on statins have similar macrophage accumulation in their carotid atherosclerotic plaques compared with patients not on statins. Inflammatory markers were also similar in both groups except for hsCRP which was significantly lower in those taking statins.

Key Words: Statins, carotid endarterectomy, macrophages, high sensitivity C reactive protein, inflammation, cholesterol..