Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal - Cardiovascular Imaging, jead110. https://doi.org/10.1093/ehjci/jead110 Dr. Hyung-Bok Park et al.
Points
- Statin therapy significantly reduces plaque progression in mild coronary artery disease (CAD), particularly in lesions with high-risk coronary atherosclerotic plaque (HRP) features.
- Patients with mild stenotic lesions and two or more HRP features experienced a 37% decrease in annualized percent atheroma volume (PAV) with statin treatment.
- Statin recipients showed a decrease in necrotic core volume and an increase in dense calcium volume compared to non-statin recipients in mild CAD lesions.
- Factors associated with rapid plaque progression in mild CAD include two or more HRP features, current smoking, and diabetes.
- Aggressive statin therapy should be considered for patients with mild CAD, especially those with a higher burden of HRP features, to reduce plaque progression and minimize the risk of adverse cardiovascular events.
Summary
This research paper aims to assess the effect of statins on the progression of high-risk coronary atherosclerotic plaque (HRP) in mild coronary artery disease (CAD) and identify predictive factors for rapid plaque progression. The study analyzed data from 613 patients with mild stenosis CAD, comprising 1432 lesions. Serial coronary computed tomography angiography (CCTA) was performed with a mean inter-scan interval of 3.5 ± 1.4 years. Plaques were quantitatively evaluated for annualized percent atheroma volume (PAV) and compositional changes based on HRP features. Rapid plaque progression was defined as PAV above the 90th percentile.
The findings demonstrated that in mild stenotic lesions with two or more HRP features, statin therapy led to a 37% reduction in annual PAV compared to non-statin recipients (0.97 ± 2.02 vs. 1.55 ± 2.22, P = 0.038). After statin treatment, these lesions exhibited decreased necrotic core volume and increased dense calcium volume. Furthermore, the study identified several key factors associated with rapid plaque progression, including the presence of two or more HRP features (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).
In conclusion, this study suggests that statin therapy reduces plaque progression in mild CAD, particularly in lesions with more HRP features. Additionally, the presence of multiple HRP features is a strong predictor of rapid plaque progression. These findings imply that aggressive statin therapy may be necessary even in cases of mild CAD with a higher burden of HRP features. The results emphasize the importance of personalized treatment strategies to mitigate plaque progression in CAD patients.
Link to the article: https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jead110/7180164
References Park, H.-B., Arsanjani, R., Sung, J. M., Heo, R., Lee, B. K., Lin, F. Y., Hadamitzky, M., Kim, Y.-J., Conte, E., Andreini, D., Pontone, G., Budoff, M. J., Gottlieb, I., Chun, E. J., Cademartiri, F., Maffei, E., Marques, H., Gonçalves, P. D. A., Leipsic, J. A., … Chang, H.-J. (2023). Impact of statins based on high-risk plaque features on coronary plaque progression in mild stenosis lesions: Results from the PARADIGM study. European Heart Journal - Cardiovascular Imaging, jead110. https://doi.org/10.1093/ehjci/jead110
