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Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study.
Eur Heart J Cardiovasc Imaging. 2019 Nov 01; 20(11):1307-1314.EH

Abstract

AIMS

Coronary artery calcium score (CACS) is a strong predictor of major adverse cardiac events (MACE). Conversely, statins, which markedly reduce MACE risk, increase CACS. We explored whether CACS progression represents compositional plaque volume (PV) progression differently according to statin use.

METHODS AND RESULTS

From a prospective multinational registry of consecutive patients (n = 2252) who underwent serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with information regarding the use of statins and having a serial CACS were included. Patients were divided into non-statin (n = 246) and statin-taking (n = 408) groups. Coronary PVs (total, calcified, and non-calcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analysed, and CACS was measured from both CCTAs. Multivariate linear regression models were constructed for both statin-taking and non-statin group to assess the association between compositional PV change and change in CACS. In multivariate linear regression analysis, in the non-statin group, CACS increase was positively associated with both non-calcified (β = 0.369, P = 0.004) and calcified PV increase (β = 1.579, P < 0.001). However, in the statin-taking group, CACS increase was positively associated with calcified PV change (β = 0.756, P < 0.001) but was negatively associated with non-calcified PV change (β = -0.194, P = 0.026).

CONCLUSION

In the non-statin group, CACS progression indicates the progression of both non-calcified and calcified PV progression. However, under the effect of statins, CACS progression indicates only calcified PV progression, but not non-calcified PV progression. Thus, the result of serial CACS should be differently interpreted according to the use of statins.

Authors+Show Affiliations

Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA.Cardiovascular Imaging Unit, SDN Foundation IRCCS, Naples, Italy.Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.Department of Internal Medicine, Busan University Hospital, Busan, South Korea.Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.Department of Radiology and Nuclear Medicine, German Heart Centre Munich, Munich, Germany.Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy.UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisbon, Portugal.Centro Cardiologico Monzino, IRCCS, Milan, Italy.Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, South Korea.Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.Department of Pathology, CVPath Institute, Gaithersburg, MD, USA.Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Centre for Cardiovascular Health, New York, NY, USA.Department of Imaging and Medicine, Cedars-Sinai Medical Centre, Los Angeles, CA, USA.Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.Department of Cardiology, Leiden University Medical Centre, ZA Leiden, The Netherlands.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA.Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea. Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Centre, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30789215

Citation

Lee, Sang-Eun, et al. "Differential Association Between the Progression of Coronary Artery Calcium Score and Coronary Plaque Volume Progression According to Statins: the Progression of AtheRosclerotic PlAque DetermIned By Computed TomoGraphic Angiography Imaging (PARADIGM) Study." European Heart Journal Cardiovascular Imaging, vol. 20, no. 11, 2019, pp. 1307-1314.
Lee SE, Sung JM, Andreini D, et al. Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study. Eur Heart J Cardiovasc Imaging. 2019;20(11):1307-1314.
Lee, S. E., Sung, J. M., Andreini, D., Budoff, M. J., Cademartiri, F., Chinnaiyan, K., Choi, J. H., Chun, E. J., Conte, E., Gottlieb, I., Hadamitzky, M., Kim, Y. J., Kumar, A., Lee, B. K., Leipsic, J. A., Maffei, E., Marques, H., Pontone, G., Raff, G., ... Chang, H. J. (2019). Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study. European Heart Journal Cardiovascular Imaging, 20(11), 1307-1314. https://doi.org/10.1093/ehjci/jez022
Lee SE, et al. Differential Association Between the Progression of Coronary Artery Calcium Score and Coronary Plaque Volume Progression According to Statins: the Progression of AtheRosclerotic PlAque DetermIned By Computed TomoGraphic Angiography Imaging (PARADIGM) Study. Eur Heart J Cardiovasc Imaging. 2019 Nov 1;20(11):1307-1314. PubMed PMID: 30789215.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study. AU - Lee,Sang-Eun, AU - Sung,Ji Min, AU - Andreini,Daniele, AU - Budoff,Matthew J, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Choi,Jung Hyun, AU - Chun,Eun Ju, AU - Conte,Edoardo, AU - Gottlieb,Ilan, AU - Hadamitzky,Martin, AU - Kim,Yong Jin, AU - Kumar,Amit, AU - Lee,Byoung Kwon, AU - Leipsic,Jonathon A, AU - Maffei,Erica, AU - Marques,Hugo, AU - Pontone,Gianluca, AU - Raff,Gilbert, AU - Shin,Sanghoon, AU - Stone,Peter H, AU - Samady,Habib, AU - Virmani,Renu, AU - Narula,Jagat, AU - Berman,Daniel S, AU - Shaw,Leslee J, AU - Bax,Jeroen J, AU - Lin,Fay Y, AU - Min,James K, AU - Chang,Hyuk-Jae, PY - 2018/08/17/received PY - 2018/09/24/revised PY - 2019/01/29/accepted PY - 2019/2/23/pubmed PY - 2019/2/23/medline PY - 2019/2/22/entrez KW - Agatston score KW - coronary artery atherosclerosis KW - coronary artery calcification KW - coronary artery calcium score KW - coronary computed tomography angiography KW - statins SP - 1307 EP - 1314 JF - European heart journal cardiovascular Imaging JO - Eur Heart J Cardiovasc Imaging VL - 20 IS - 11 N2 - AIMS: Coronary artery calcium score (CACS) is a strong predictor of major adverse cardiac events (MACE). Conversely, statins, which markedly reduce MACE risk, increase CACS. We explored whether CACS progression represents compositional plaque volume (PV) progression differently according to statin use. METHODS AND RESULTS: From a prospective multinational registry of consecutive patients (n = 2252) who underwent serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with information regarding the use of statins and having a serial CACS were included. Patients were divided into non-statin (n = 246) and statin-taking (n = 408) groups. Coronary PVs (total, calcified, and non-calcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analysed, and CACS was measured from both CCTAs. Multivariate linear regression models were constructed for both statin-taking and non-statin group to assess the association between compositional PV change and change in CACS. In multivariate linear regression analysis, in the non-statin group, CACS increase was positively associated with both non-calcified (β = 0.369, P = 0.004) and calcified PV increase (β = 1.579, P < 0.001). However, in the statin-taking group, CACS increase was positively associated with calcified PV change (β = 0.756, P < 0.001) but was negatively associated with non-calcified PV change (β = -0.194, P = 0.026). CONCLUSION: In the non-statin group, CACS progression indicates the progression of both non-calcified and calcified PV progression. However, under the effect of statins, CACS progression indicates only calcified PV progression, but not non-calcified PV progression. Thus, the result of serial CACS should be differently interpreted according to the use of statins. SN - 2047-2412 UR - https://www.unboundmedicine.com/medline/citation/30789215/Differential_association_between_the_progression_of_coronary_artery_calcium_score_and_coronary_plaque_volume_progression_according_to_statins:_the_Progression_of_AtheRosclerotic_PlAque_DetermIned_by_Computed_TomoGraphic_Angiography_Imaging__PARADIGM__study_ L2 - https://academic.oup.com/ehjcimaging/article-lookup/doi/10.1093/ehjci/jez022 DB - PRIME DP - Unbound Medicine ER -