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Published on: January 15, 2022
Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: results
Hyung-Bok Park1,2, Reza Arsanjani3, Ji Min Sung2
1Department of Cardiology, Catholic Kwandong University International St. Mary's Hospital, Incheon, South Korea.
Insights
Statin therapy significantly reduced coronary plaque progression in patients with mild coronary artery disease (CAD), especially those with high-risk plaque (HRP) features. Aggressive statin use is recommended for mild CAD with multiple HRPs.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) management often focuses on significant stenosis, but plaque progression in mild CAD is also critical.
- High-risk plaque (HRP) features identified by coronary computed tomography angiography (CCTA) may indicate vulnerable lesions.
- Understanding factors driving plaque progression is essential for timely intervention.
Purpose of the Study:
- To evaluate the effect of statin therapy on coronary atherosclerotic plaque progression.
- To analyze plaque progression based on the presence of HRP features in mild CAD.
- To identify predictors of rapid plaque progression in mild CAD.
Main Methods:
- Analysis of 1432 mild CAD lesions from 613 patients using serial CCTA (≥2-year interval).
- Quantitative assessment of plaque volume changes and annualized percent atheroma volume (PAV).
- Definition of rapid plaque progression as ≥90th percentile annual PAV.
Main Results:
- Statin therapy reduced annual PAV by 37% in lesions with ≥2 HRPs (P=0.038).
- Statin use was associated with decreased necrotic core and increased dense calcium volumes.
- Predictors of rapid plaque progression included ≥2 HRPs (HR 1.89), current smoking (HR 1.69), and diabetes (HR 1.55).
Conclusions:
- Statin treatment effectively reduces plaque progression in mild CAD, particularly in lesions with multiple HRP features.
- The number of HRP features is a significant predictor of rapid plaque progression.
- Consideration of aggressive statin therapy is warranted for mild CAD patients with numerous HRPs.
Aims:
To investigate the impact of statins on plaque progression according to high-risk coronary atherosclerotic plaque (HRP) features and to identify predictive factors for rapid plaque progression in mild coronary artery disease (CAD) using serial coronary computed tomography angiography (CCTA).
Methods And Results:
We analyzed mild stenosis (25-49%) CAD, totaling 1432 lesions from 613 patients (mean age, 62.2 years, 63.9% male) and who underwent serial CCTA at a ≥2 year inter-scan interval using the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (NCT02803411) registry. The median inter-scan period was 3.5 ± 1.4 years; plaques were quantitatively assessed for annualized percent atheroma volume (PAV) and compositional plaque volume changes according to HRP features, and the rapid plaque progression was defined by the ≥90th percentile annual PAV. In mild stenotic lesions with ≥2 HRPs, statin therapy showed a 37% reduction in annual PAV (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038) with decreased necrotic core volume and increased dense calcium volume compared to non-statin recipient mild lesions. The key factors for rapid plaque progression were ≥2 HRPs [hazard ratio (HR), 1.89; 95% confidence interval (CI), 1.02-3.49; P = 0.042], current smoking (HR, 1.69; 95% CI 1.09-2.57; P = 0.017), and diabetes (HR, 1.55; 95% CI, 1.07-2.22; P = 0.020).
Conclusion:
In mild CAD, statin treatment reduced plaque progression, particularly in lesions with a higher number of HRP features, which was also a strong predictor of rapid plaque progression. Therefore, aggressive statin therapy might be needed even in mild CAD with higher HRPs.
Clinical Trial Registration:
ClinicalTrials.gov NCT02803411.
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