Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study.

Abstract

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).

• Authors: Sang-Eun Lee, Hyuk-Jae Chang, Ji Min Sung, Hyung-Bok Park, Ran Heo, Asim Rizvi, Fay Y Lin, Amit Kumar, Martin Hadamitzky, Yong Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J Budoff, Ilan Gottlieb, Byoung Kwon Lee, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Jonathon A Leipsic, Sanghoon Shin, Jung Hyun Choi, Kavitha Chinnaiyan, Gilbert Raff, Renu Virmani, Habib Samady, Peter H Stone, Daniel S Berman, Jagat Narula, Leslee J Shaw, Jeroen J Bax, James K Min
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 11 Issue 10 Pg. 1475-1484 (10 2018) ISSN: 1876-7591 [Electronic] United States
• PMID: 29909109 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Brazil
• Computed Tomography Angiography
• Coronary Angiography (methods)
• Coronary Artery Disease (diagnostic imaging, drug therapy, pathology)
• Coronary Stenosis (diagnostic imaging, drug therapy, pathology)
• Coronary Vessels (diagnostic imaging, drug effects, pathology)
• Disease Progression
• Europe
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (adverse effects, therapeutic use)
• Male
• Middle Aged
• North America
• Plaque, Atherosclerotic
• Prospective Studies
• Registries
• Republic of Korea
• Severity of Illness Index
• Time Factors
• Treatment Outcome
• Vascular Calcification (diagnostic imaging, pathology)