Effect of long-term intensive cholesterol control on the plaque progression in elderly based on CTA cohort study
Ting Sun1, Yabin Wang1, Xinjiang Wang2
1Chinese PLA Medical College & Department of Cardiology, National Clinic Research Center Geriatric Disease, 2nd Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
Insights
Intensive LDL cholesterol lowering in elderly patients slowed stenosis progression but increased plaque calcification and percent calcified plaque volume. Serial coronary CT angiography (CCTA) aids risk stratification.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Geriatric Medicine
Background:
- Coronary artery disease (CAD) risk is influenced by lipid levels.
- Assessing plaque progression and composition is crucial for managing CAD.
- Long-term effects of intensive lipid-lowering on coronary plaque characteristics require further investigation.
Purpose of the Study:
- To evaluate the long-term impact of intensive LDL cholesterol-lowering treatments on coronary plaque features.
- To analyze changes in lumen stenosis, calcification, and plaque volume using coronary computed tomography angiography (CCTA).
- To assess the effect on Agatston coronary artery calcium score (CACS) in elderly patients.
Main Methods:
- Retrospective analysis of serial CCTA scans from 240 elderly patients (over 60 years) over 5 years.
- Patients were stratified into intensive lipid-lowering, lipid-lowering, and control groups.
- Quantitative analysis of stenosis severity, plaque volume (PV), plaque composition, percent calcified plaque volume (PCPV), and high-risk plaque (HRP) presence; CACS calculated at baseline and follow-up.
Main Results:
- Intensive LDL-lowering was associated with a decrease in spotty calcifications and no significant change in obstructive lesions.
- Patients in the intensive group showed increased calcified PV, CACS, and PCPV progression.
- A significant reduction in fibrous-fatty and lipid-rich PV was observed in the intensive group compared to others.
Conclusions:
- Gradual increases in plaque volume and content occurred over time in all groups.
- Intensive LDL-lowering slowed stenosis progression and reduced high-risk plaque features but increased coronary calcification and PCPV progression.
- Serial CCTA evaluations can refine risk stratification and guide lipid-lowering strategies in elderly patients.
Objectives:
To investigate the long-term effects of intensive LDL cholesterol-lowering treatments on lumen stenosis severity, plaque calcification, spotty calcifications, percent calcified plaque volume (PCPV), and Agatston coronary artery calcium score (CACS) based on coronary computed tomography angiography (CCTA) in elderly patients.
Methods:
A total of 240 patients over 60 years old (comprising 754 lesions) who underwent serial CCTA were retrospectively enrolled in this 5-year cohort study. Patients were divided into three groups: an intensive lipid-lowering group, a lipid-lowering group, and a control group. The stenosis severity, plaque volume (PV), plaque composition, PCPV, and high-risk plaque (HRP) presence were quantitatively analyzed. The CACS was calculated at baseline and follow-up.
Results:
All patients were male with an average age of 66.8 ± 5.8 years old. Over time, increases in the percentages of obstructive coronary lesions (p < 0.001) were observed. Compared with those at baseline, the percentage of obstructive lesions remained unchanged (p = 0.077), and the percentage of spotty calcifications significantly decreased (p < 0.05) at the follow-up CCTA scan in the intensive lipid-lowering group. Patients in the intensive lipid-lowering group demonstrated a higher progression in calcified PV, CACS, and PCPV (all p < 0.05), and a significantly greater attenuation in fibrous-fatty and lipid-rich PV (all p < 0.05) than patients in other groups.
Conclusions:
The PV and contents increased gradually with time in all groups. Intensive LDL-C lowering was associated with slower progression of stenosis severity and reduction of high-risk plaque features, with increased plaque calcification and higher progression in PCPV. Comprehensive serial plaque evaluations by CCTAs may contribute to further refinement of risk stratification and reasonable lipid-lowering treatment in elderly patients.
Key Points:
• Intensive LDL-C lowering increased coronary calcification and percent calcified plaque volume progression. • Comprehensive serial plaque evaluations by serial CCTAs may help to refine risk stratification.
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