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 mm2; p = 0.001; and, respectively, 13.10 ± 5.77 vs 20.19 ± 24.08 mm3; 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.