TY - JOUR
T1 - Impact of statins on serial coronary calcification during atheroma progression and regression
AU - Puri, Rishi
AU - Nicholls, Stephen J.
AU - Shao, Mingyuan
AU - Kataoka, Yu
AU - Uno, Kiyoko
AU - Kapadia, Samir R.
AU - Tuzcu, E. Murat
AU - Nissen, Steven E.
N1 - Publisher Copyright:
© 2015 by the American College of Cardiology Foundation.
PY - 2015
Y1 - 2015
N2 - BACKGROUND Statins can regress coronary atheroma and lower clinical events. Although pre-clinical studies suggest procalcific effects of statins in vitro, it remains unclear if statins can modulate coronary atheroma calcification in vivo. OBJECTIVES This study compared changes in coronary atheroma volume and calcium indices (CaI) in patients receiving high-intensity statin therapy (HIST), low-intensity statin therapy (LIST), and no-statin therapy. METHODS In a post-hoc patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound, serial changes in coronary percent atheroma volume (PAV) and CaI were measured across matched coronary segments in patients with coronary artery disease. RESULTS Following propensity-weighted adjustment for differences in baseline and changes in clinical, laboratory, and ultrasonic characteristics, HIST (n = 1,545) associated with PAV regression from baseline (-0.6 ± 0.1%; p < 0.001), whereas both LIST (n = 1,726) and no-statin therapy (n = 224) associated with PAV progression (0.8 ± 0.1% and 1.0 ± 0.1%; p < 0.001, respectively; p < 0.001 for both HIST vs. LIST and HIST vs. no-statin; p = 0.35 for LIST vs. no-statin). Significant increases in CaI from baseline were noted across all groups (median [interquartile range] HIST, 0.044 [0.0-0.12]; LIST, 0.038 [0.0-0.11]; no-statin, 0.020 [0.0-0.10]; p < 0.001 for all), which could relate to statin intensity (p = 0.03 for LIST vs. no-statin; p = 0.007 for HIST vs. no-statin; p = 0.18 for HIST vs. LIST). No correlations were found between changes in CaI and on-treatment levels of atherogenic and antiatherogenic lipoproteins, and C-reactive protein, in either of the HIST groups or the no-statin group. CONCLUSIONS Independent of their plaque-regressive effects, statins promote coronary atheroma calcification. These findings provide insight as to how statins may stabilize plaque beyond their effects on plaque regression.
AB - BACKGROUND Statins can regress coronary atheroma and lower clinical events. Although pre-clinical studies suggest procalcific effects of statins in vitro, it remains unclear if statins can modulate coronary atheroma calcification in vivo. OBJECTIVES This study compared changes in coronary atheroma volume and calcium indices (CaI) in patients receiving high-intensity statin therapy (HIST), low-intensity statin therapy (LIST), and no-statin therapy. METHODS In a post-hoc patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound, serial changes in coronary percent atheroma volume (PAV) and CaI were measured across matched coronary segments in patients with coronary artery disease. RESULTS Following propensity-weighted adjustment for differences in baseline and changes in clinical, laboratory, and ultrasonic characteristics, HIST (n = 1,545) associated with PAV regression from baseline (-0.6 ± 0.1%; p < 0.001), whereas both LIST (n = 1,726) and no-statin therapy (n = 224) associated with PAV progression (0.8 ± 0.1% and 1.0 ± 0.1%; p < 0.001, respectively; p < 0.001 for both HIST vs. LIST and HIST vs. no-statin; p = 0.35 for LIST vs. no-statin). Significant increases in CaI from baseline were noted across all groups (median [interquartile range] HIST, 0.044 [0.0-0.12]; LIST, 0.038 [0.0-0.11]; no-statin, 0.020 [0.0-0.10]; p < 0.001 for all), which could relate to statin intensity (p = 0.03 for LIST vs. no-statin; p = 0.007 for HIST vs. no-statin; p = 0.18 for HIST vs. LIST). No correlations were found between changes in CaI and on-treatment levels of atherogenic and antiatherogenic lipoproteins, and C-reactive protein, in either of the HIST groups or the no-statin group. CONCLUSIONS Independent of their plaque-regressive effects, statins promote coronary atheroma calcification. These findings provide insight as to how statins may stabilize plaque beyond their effects on plaque regression.
KW - Atherosclerosis
KW - Calcium
KW - Intravascular ultrasound
KW - Statins
UR - http://www.scopus.com/inward/record.url?scp=84930339080&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2015.01.036
DO - 10.1016/j.jacc.2015.01.036
M3 - Article
C2 - 25835438
AN - SCOPUS:84930339080
SN - 0735-1097
VL - 65
SP - 1273
EP - 1282
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 13
ER -