Impact of statin therapy intensity on endothelial progenitor cells after percutaneous coronary intervention in diabetic patients. The REMEDY-EPC late study

Background: A low number (that is, <= 0.0038 per 100 peripheral mononuclear cells) of circulating endothelial progenitor cells (EPC) is common in diabetic patients. Statins increase EPC levels. It is unclear whether intensity of statin therapy has a different impact on EPC levels. Methods: Diabetic patients undergoing drug-eluting stent (DES) implantation were randomized to 1) High intensity statin therapy (atorvastatin 80 mg/day; n = 66) or 2) Moderate intensity statin therapy (atorvastatin 20 mg/day; n = 64). EPC levels were assessed at baseline, 24 h and 3 months. Endpoints assessed at 3 months were 1) changes in the proportion of patients with low EPC levels, and 2) uncovered struts rate and neointima growth evaluated by optical coherence tomography. Results: Low EPC levels rate significantly decreased in the High intensity statin therapy group (from 31.7\% to 12.7\%; p = 0.017) but not in the Moderate intensity statin therapy group (from 25.5\% to 21.8\%; p = 0.81). Uncovered struts rate was similar in the 2 groups (2.4 +/- 2.6\% vs 2.3 +/- 2.2\%; p = 0.82), whereas mean neointima area and volume were lower in the High intensity statin therapy group (0.68 +/- 0.69 vs 1.22 +/- 1.29 mm(2); p = 0.001; and, respectively, 13.10 +/- 5.77 vs 20.19 +/- 24.08 mm(3); p = 0.042). Conclusions: In diabetic patients, a high intensity statin therapy 1) significantly increases EPC levels and decreases in-stent neointima area and volume, and 2) does not have an impact on the degree of stent re-endothelialization at 3 months after DES implantation. (C) 2017 Elsevier B.V. All rights reserved.