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Plaque regression with alternate-day statin and daily ezetimibe. A, A soft plaque is shown at the origin of the left external carotid in a 63-year-old man using ezetimibe alone, having stopped statin because of statin myopathy. His plaque area had progressed from 20 mm2 6 months earlier, to 28 mm2. B, After adding back rosuvastatin 5 mg daily with CoQ10 200 mg daily to prevent myalgias, the plaque area regressed to 0.19 mm2 in just over 3 months. The plaque had also become denser, with regression of the soft plaque and more calcification. Reproduced by permission of the publisher from Spence and Hackam.130
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April 2009, his plaque area had progressed to 29 mm2, a matter of concern since Spence et al reported in 2002127 that plaque progression was associated with a doubling of risk. (This was the basis for developing a new approach to managing atherosclerosis, "treating arteries instead of treating risk factors,"130 which markedly reduced risk among high-risk patients.131) Because of the plaque progression, he began taking rosuvastatin 5 mg on alternate days with an increased dose of CoQ10 (200 mg daily). As shown in Figure 2,130 the plaque area regressed in just over 3 months to 19 mm2.