TY - JOUR
T1 - Effects of Statins on Coronary Atherosclerotic Plaques
T2 - The PARADIGM Study
AU - Lee, Sang Eun
AU - Chang, Hyuk Jae
AU - Sung, Ji Min
AU - Park, Hyung Bok
AU - Heo, Ran
AU - Rizvi, Asim
AU - Lin, Fay Y.
AU - Kumar, Amit
AU - Hadamitzky, Martin
AU - Kim, Yong Jin
AU - Conte, Edoardo
AU - Andreini, Daniele
AU - Pontone, Gianluca
AU - Budoff, Matthew J.
AU - Gottlieb, Ilan
AU - Lee, Byoung Kwon
AU - Chun, Eun Ju
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Marques, Hugo
AU - Leipsic, Jonathon A.
AU - Shin, Sanghoon
AU - Choi, Jung Hyun
AU - Chinnaiyan, Kavitha
AU - Raff, Gilbert
AU - Virmani, Renu
AU - Samady, Habib
AU - Stone, Peter H.
AU - Berman, Daniel S.
AU - Narula, Jagat
AU - Shaw, Leslee J.
AU - Bax, Jeroen J.
AU - Min, James K.
N1 - Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/10
Y1 - 2018/10
N2 - Objectives: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. Background: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. Methods: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. Results: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. Conclusions: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation.
AB - Objectives: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques. Background: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear. Methods: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications. Results: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development. Conclusions: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation.
KW - coronary artery atherosclerosis
KW - coronary artery disease
KW - coronary computed tomography angiography
KW - statins
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U2 - 10.1016/j.jcmg.2018.04.015
DO - 10.1016/j.jcmg.2018.04.015
M3 - Article
C2 - 29909109
AN - SCOPUS:85048199426
SN - 1936-878X
VL - 11
SP - 1475
EP - 1484
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 10
ER -