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Impact of statins on serial coronary calcification during atheroma progression and regression.
J Am Coll Cardiol. 2015 Apr 07; 65(13):1273-1282.JACC

Abstract

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.

Authors+Show Affiliations

Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia.Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio.South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, South Australia, Australia.Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio.Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland, Ohio; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: nissens@ccf.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25835438

Citation

Puri, Rishi, et al. "Impact of Statins On Serial Coronary Calcification During Atheroma Progression and Regression." Journal of the American College of Cardiology, vol. 65, no. 13, 2015, pp. 1273-1282.
Puri R, Nicholls SJ, Shao M, et al. Impact of statins on serial coronary calcification during atheroma progression and regression. J Am Coll Cardiol. 2015;65(13):1273-1282.
Puri, R., Nicholls, S. J., Shao, M., Kataoka, Y., Uno, K., Kapadia, S. R., Tuzcu, E. M., & Nissen, S. E. (2015). Impact of statins on serial coronary calcification during atheroma progression and regression. Journal of the American College of Cardiology, 65(13), 1273-1282. https://doi.org/10.1016/j.jacc.2015.01.036
Puri R, et al. Impact of Statins On Serial Coronary Calcification During Atheroma Progression and Regression. J Am Coll Cardiol. 2015 Apr 7;65(13):1273-1282. PubMed PMID: 25835438.
* Article titles in AMA citation format should be in sentence-case
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, PY - 2014/11/21/received PY - 2015/01/13/revised PY - 2015/01/20/accepted PY - 2015/4/4/entrez PY - 2015/4/4/pubmed PY - 2015/6/5/medline KW - atherosclerosis KW - calcium KW - intravascular ultrasound KW - statins SP - 1273 EP - 1282 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 65 IS - 13 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/25835438/Impact_of_statins_on_serial_coronary_calcification_during_atheroma_progression_and_regression_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(15)00301-0 DB - PRIME DP - Unbound Medicine ER -