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To the Editor: Dr Meuwese and colleagues¹ presented results of the Carotid Atherosclerosis Progression Trial Investigating Vascular ACAT Inhibition Treatment Effects (CAPTIVATE). In this study, patients who were heterozygous for familial hypercholesterolemia were randomized to receive either pactimibe (a nonspecific acyl coenzyme A:cholesterol acyltransferase [ACAT] inhibitor) or placebo, in addition to standard lipid-lowering therapy. Consistent with data from macrophage ACAT1 knockout mice, treatment with a nonspecific ACAT inhibitor may not result in apparent positive effects on atherosclerosis.²

Although the authors did not provide evidence that either ACAT-1 or ACAT-2 was inhibited by the treatment regimen in this study, they discussed the possibility that the pactimibe treatment was accessing both ACAT enzymes. It is likely that any effect on thickness of the artery wall (where ACAT-1 resides²) would be related to ACAT-1 inhibition. However, the discussion focused on ACAT-2. It was suggested that ACAT-2 might be up-regulated in human atherosclerotic . . . [Full Text of this Article]

Paolo Parini, MD, PhD
paolo.parini@ki.se
Department of Laboratory Medicine

Mats Eriksson, MD, PhD
Department of Medicine
Karolinska Institutet
Stockholm, Sweden

Lawrence L. Rudel, PhD
Department of Pathology
Wake Forest University School of Medicine
Winston-Salem, North Carolina

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RELATED ARTICLE

ACAT Inhibition and Progression of Carotid Atherosclerosis in Patients With Familial Hypercholesterolemia: The CAPTIVATE Randomized Trial
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Carotid Atherosclerosis Progression and ACAT Inhibition
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Carotid Atherosclerosis Progression and ACAT Inhibition—Reply
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