Accessibility Copyright 2018 Elsevier B.V. All rights reserved. 1 Because the precise mechanisms by which statins exert a survival benefit are incompletely explained by their effect on serum lipids, 2 intense efforts have focused on inflammatory effects, both systemically and locally at the plaque itself. Henein MY, Vancheri S, Longo G, Vancheri F. Int J Mol Sci. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. Cardiovascular disease (CVD) is currently one of the most important health problems in the world, causing one-third of all global deaths (17.3 million deaths per year). The benefit of statins on exercise tolerance may be greater in patients with moderate-severe arterial stenosis (defined as an ABI <0.7) than in those with mild stenosis, which has been attributed to a possible regression and stability of the atheroma plaque in cases of more advanced atherosclerotic lesions with a higher lipid load on the plaque . Osei et al. Second, most research on the allocation of add-on therapies guided by CAC implicitly assumed that baseline rather than follow-up CAC scores would inform such allocation, and that this would happen in mostly statin-nave populations.26,28,29 Accordingly, in patients with an initial (first) CAC scan >100, it may be reasonable to initiate not only statins, but also other relevant preventive medications early on without the need for repeat CAC scanning later in time. [Association of statin treatment with progression of coronary atherosclerotic plaque composition. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Statin side effects: Weigh the benefits and risks, Newsletter: Mayo Clinic Health Letter Digital Edition, Book: Mayo Clinic Family Health Book, 5th Edition, Nutritional Supplements at Mayo Clinic Store. To better understand the changes associated with statin therapy on certain plaque subtypes, the authors enrolled 2,252 patients from the CCTA PARADIGM study. Whether these benefits are purely through lipid lowering or pl Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. Components of the score including volume, area, and density were quantified. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. Association of statin treatment with progression of coronary atherosclerotic plaque composition. Statin intolerance. The study excluded patients with noninterpretable CCTA findings, patients without lesions at baseline as well as at follow-up, patients initiating or stopping statin after baseline CCTA, patients with unknown information regarding statin use, and those with tandem lesions at baseline that were confluent at follow-up. , low-attenuation plaque was a better predictor of future events than other commonly used measures, such as a cardiovascular risk score. Conclusions: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Of the seven different statins on the market, six are available generically ( TABLE 1 ). http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. The new study, which was published last week in. Dizziness is commonly associated with statin use, possibly due to blood pressure-lowering effects. Epub 2022 Jun 23. Importantly, coronary artery plaque burden predicts risk of MACE. Adverse effects of statin therapy: Perception vs. the evidence focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. 2023 American College of Cardiology Foundation. 2022 May 27;13:899241. doi: 10.3389/fendo.2022.899241. Statin therapy has been shown to control LDL-C, thereby reducing the risk of cardiovascular events by 25-35%. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. It was unclear, however, whether the associations with events would be as strong as those in statin-nave populations. Statins: Actions, side effects and administration. Current statin treatment was also associated with a lower presence of lipid core (OR: 0.66 [95% CI: 0.42-1.04]), but only when using statins for 10 months or less. Computer software automatically identifies on the scan. Type 2 diabetes or high blood sugar. Statin therapy was associated with decreased plaque volume in low attenuation plaques and fibro-fatty plaques, but not in the calcified plaques. AskMayoExpert. So having really a low LDL cholesterol level can help stabilize any plaque buildup you have, and prevent further plaque progression. The FDA warns on statin labels that some people have developed memory loss or confusion while taking statins. A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. Using fixed Hounsfield units, coronary lesions were categorized by plaque volumes and calcium composition as low-attenuation plaque, fibro-fatty plaque, fibrous plaque, low-density calcium, high-density calcium, and very densely calcified 1K plaque. In the placebo group (placebo + statin), patients achieved an average LDL-c level of 74.4 mg/dL (1.9 mmol/L) at week 52 (reduction of 50.7% compared to baseline). Its like a rock that doesnt grow.. All analyses were stratified by baseline statin use. The effect of CAC score on predictive value by AUROC are summarized in Table 2. Interventions and Coronary Artery Disease, Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure, Aspirin vs. Clopidogrel for Long-Term Maintenance After PCI, Harmonizing Optimal Strategy for Treatment of Coronary Artery StenosisExtended Antiplatelet Monotherapy, ACC Accreditation Firsts: Vietnam Facilities Awarded For HF and Cardiac Cath Lab Programs, Tennessee Hospital Earns Chest Pain Center Certification, Percutaneous Complete Revascularization Strategies Using Sirolimus-Eluting Biodegradable Polymer-Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. Background: Using these modalities, it was noted that statin therapy is associated with a decrease in lipid-rich plaque and an increase in calcification. The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. There was a statistically significant interaction by baseline statin use, resulting in weaker associations between Agatston CAC scores and both outcomes. 2023 American College of Cardiology Foundation. Journal of Atherosclerosis and Thrombosis. We used logistic regression models to study the association of statin use with the presence of plaque components. The latter subgroup adds "noise" to the association, taking HRs closer to the null value. Disclaimer. information and will only use or disclose that information as set forth in our notice of Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihypertensive therapy. The German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. Coronary artery calcium and cardiovascular events in patients With familial hypercholesterolemia receiving standard lipid-lowering therapy. Combining cholesterol-lowering strategies with imaging data: a visible benefit? Study limitations include the observational study design, lack of statin dosing information, and potential selection bias. "If we have a 30% blockage in the artery from soft plaque, the goal is to try to suck out the cholesterol from the inside, so the plaque shrivels down to 15% and leaves nothing inside it . The progression of atherosclerotic plaque composition has been previously described with intravascular ultrasound and CCTA. Active, high-dosage statin use seems to beneficially influence the composition of carotid atherosclerosis by shifting the composition from vulnerable plaque with a lipid core to more stable calcified plaque. Epub 2019 May 3. Effects of statins on coronary atherosclerotic plaques: the PARADIGM Study. Which statins are the exception? Remember that statin medications can reduce your risk of a heart attack or stroke, and the risk of life-threatening side effects from statins is very low. Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Keywords: Dyslipidemias, Calcium, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Coronary Vessels, Hyperlipoproteinemia Type II, Secondary Prevention, Research Design, Reference Values, Prognosis, Retrospective Studies, Follow-Up Studies, Area Under Curve, Coronary Disease, Risk Factors, Risk Assessment, Diabetes Mellitus, Diabetes Mellitus, Risk Reduction Behavior, Chest Pain, Atherosclerosis, Cardiology, Reference Standards, Acceleration, Aspirin, Lipids, Resource Allocation. Pathologically, free calcium is released from dying macrophages and smooth muscle cells crystalize into microcalcifications in the deeper necrotic core, and later coalesce and form denser calcium sheets.8. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. Drug-induced diabetes mellitus: Evidence for statins and other drugs affecting glucose metabolism. Before van Rosendael reports grant support from the National Research Foundation of Korea and ICT. Specifically, statin therapy is associated with a decrease in low-attenuation and fibro-fatty plaque volumes and an increase in high-density and 1K volumes. For patients undergoing CAC screening, the new data can help refine how best to assess patient risk. This content does not have an Arabic version. Retrospective cohort analysis using data from the CAC Consortium focused on subjects with information on baseline statin use (n=28,025), with a mean follow-up of 11 years. This data supports results previously reported in the ICONIC study, which showed that coronary plaque in patients with acute coronary syndrome had larger volume of noncalcified components, possibly reflecting an earlier, more active stage of atherosclerosis.5 Conversely, data from MESA and ICONIC revealed higher plaque calcium density in patients with lower risk of cardiac events.3,4 It is conceivable that the presence of high-density calcium sheets implies that plaque naturally progressed to a more stable form. Even if your side effects are frustrating, don't stop taking your statin medication for any period of time without talking to your doctor first. Direct visualization of CAD by coronary computed tomography angiography (CCTA) provides high diagnostic accuracy comparable to the reference standard of invasive coronary angiography (ICA). Role of coronary artery calcium for stratifying cardiovascular risk in adults with hypertension. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This content does not have an English version. If its 90% dense calcium, for example, it doesnt progress on the next CT scan. Therapeutic effects of resveratrol and Omega-3 in mice atherosclerosis: focus on histopathological changes. To provide you with the most relevant and helpful information, and understand which The .gov means its official. Coronary artery disease (CAD) is highly prevalent and if inadequately treated can often lead to major adverse cardiovascular events (MACE).1 Treatment begins with aggressive lifestyle and behavioral modifications, but often requires pharmacologic therapy with statin therapy for appropriate risk factor control in those with elevated atherosclerotic cardiovascular disease (ASCVD) risk. Of these, 171,189 (13.7%) had at least 1 reported SASE since year 2000. Statins Positively Alter Coronary Plaque Composition, What is evident in the statin-treated patients, said lead investigator Alexander, studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK. ](Source Hyperlinks https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117 ) JAMA Cardiol. If the plaque is mainly composed of very dense calcium, then itll progress less in total volume, said van Rosendael. The aim of the present study was to compare the effects of statin /ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18 F-fluorodeoxyglucose (18 FDG . Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. Targets for plaque stabilization LDL cholesterol and cardiovascular events. Within this observational registry, in which patients underwent serial coronary CTA at least 2 years apart (median 3.2 years), 548 were treated with statins and 309 were untreated. Statin treatment was associated with a higher presence of calcification (OR: 1.73 [95% CI: 1.22-2.44]). The findings confirm that CAC does have prognostic value among statin users, although the association is attenuated. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the multicenter SCOT-HEART trial (Scottish Computed Tomography of the HEART). Effects of Statins on CoronaryAtherosclerotic Plaques: The PARADIGM Study. Figure 1: Courtesy of Kazzi BE, Feldman DI, Blumenthal RS, Zadeh AA. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. We aimed to investigate the association of statin treatment with the presence of different plaque components located in the carotid arteries within a population-based setting. Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. He completed his undergraduate degrees at Queens. Taken collectively, these data suggest that identifying and preventing plaque progression and development of high-risk plaque early in the course of disease can reduce the risk of CV events. Statin therapy appears to accelerate the process of transforming a potentially highly metabolically active plaque to a more inert state. Accessed Jan. 25, 2019. This difference in mortality rate blunts the association for statin users compared to nonusers; however, absolute increases in mortality rate are similar with increasing CAC score (Table 1). A narrative review. Guo BC, Kuo KL, Huang JW, Chen CH, Tarng DC, Lee TS. Mszar R, Nasir K, Santos RD. Malik S, Zhao Y, Budoff M, et al. Understand which the.gov means its official, Intraplaque Hemorrhage and lipid Core within the atherosclerotic. Are summarized in TABLE 2 unclear, however, whether the associations with events be. Provide you with the presence of plaque components visible benefit findings confirm that CAC does have prognostic among! 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