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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)
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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)
KW - coronary artery atherosclerosis
KW - coronary artery disease
KW - coronary computed tomography angiography
KW - statins
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UR - http://www.scopus.com/inward/citedby.url?scp=85048199426&partnerID=8YFLogxK
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 -