2022 Nov 17;84:104846. doi: 10.1016/j.amsu.2022.104846. All Rights Reserved. Ann Med Surg (Lond). Cleveland Clinic is a non-profit academic medical center. German CA, Shapiro MD. Coronary artery disease (CAD) is highly prevalent and if inadequately treated can often lead to major adverse cardiovascular events (MACE).1 Treatment begins with aggressive lifestyle and behavioral modifications, but often requires pharmacologic therapy with statin therapy for appropriate risk factor control in those with elevated atherosclerotic cardiovascular disease (ASCVD) risk. Using these modalities, it was noted that statin therapy is associated with a decrease in lipid-rich plaque and an increase in calcification. Two statins in particular, atorvastatin, which is sold under the brand name Lipitor, and rosuvastatin, which is sold under the brand name Crestor, are the strongest statins. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK. In SCOT-HEART, low-attenuation plaque was a better predictor of future events than other commonly used measures, such as a cardiovascular risk score, coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. Data on concealment of allocation, selection bias, blinding, sample size, disclosed funding source, financial ties of authors, results for primary outcomes, and author conclusions were extracted by two coders (weighted kappa 0.80 to 0.97). Meta-analysis comparing the effects of rosuvastatin versus atorvastatin on regression of coronary atherosclerotic plaques Am J Cardiol. The risk is small but important enough that the Food and Drug Administration (FDA) has issued a warning on statin labels regarding blood glucose levels and diabetes. Specifically, statin therapy is associated with a decrease in low-attenuation and fibro-fatty plaque volumes and an increase in high-density and 1K volumes. ](Source Hyperlinks https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117 ) JAMA Cardiol. This data supports results previously reported in the ICONIC study, which showed that coronary plaque in patients with acute coronary syndrome had larger volume of noncalcified components, possibly reflecting an earlier, more active stage of atherosclerosis.5 Conversely, data from MESA and ICONIC revealed higher plaque calcium density in patients with lower risk of cardiac events.3,4 It is conceivable that the presence of high-density calcium sheets implies that plaque naturally progressed to a more stable form. An official website of the United States government. The site is secure. Having too much cholesterol in your blood increases your risk of heart attacks and strokes. Macroscopic calcification is uncommon in the early stages of atherosclerosis while its invariable presence during its later stages likely is related to decreasing inflammation and organization. Statins: Actions, side effects and administration. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. About cholesterol. In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. 6 In the early 20th century, cholesterol plaques were found within the coronary arteries of patients who had died after suffering from angina pectoris. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the HUYGENS study, which is an OCT investigation into changes in atherosclerotic plaque composition among ACS patients treated with statins and the PCSK9 inhibitor evolocumab (Repatha; Amgen). CRF is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. Long-term all-cause and cause-specific mortality in asymptomatic patients with CAC 1,000: results from the CAC Consortium. Among patients with plaque progression, rates of subsequent events are about 15-20% at 12 months compared with <1% among patients without progression. studied the association of statin therapy with progression of coronary plaque composition. 2019 Nov;29(8):456-457. doi: 10.1016/j.tcm.2019.02.001. A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. First, increases in Agatston CAC scores caused by statins are modest and therefore very elevated CAC scores, e.g., >400 or >1000, should still be interpreted as indicative of extensive atherosclerosis and trigger aggressive preventive pharmacologic management. Computer software automatically identifies on the scan. The Role of Inflammation in Cardiovascular Disease. Cardiovascular disease (CVD) is currently one of the most important health problems in the world, causing one-third of all global deaths (17.3 million deaths per year). A: Yes. The German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the. Therapeutic effects of resveratrol and Omega-3 in mice atherosclerosis: focus on histopathological changes. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. Arnett DK, Blumenthal RS, Albert MA, et al. Keywords: We know that statins reduce the risk of heart attacksthats been proven many, many timesso we wanted to know whether statins increase the good plaque, the very dense calcium, and decrease the very-high-risk plaque.. Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. Accessed Jan. 29, 2019. government site. Higher calcium density is associated with slowed plaque progression. AskMayoExpert. Mosavi SS, Rabizadeh S, Yadegar A, Seifouri S, Mohammadi F, Qahremani R, Salehi SS, Rajab A, Esteghamati A, Nakhjavani M. BMC Complement Med Ther. Clinical studies using ultrasound in the coronary arteries have shown that when you are on high doses of these medicines, even if you have plaque buildup already, you can stabilize the plaque on statin therapy. Because the condition affects every artery, if . "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Some drugs that may interact with statins and increase your risk of side effects include: There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins. We know that there are different compositions of the plaque, he said. Achenbach S, Ropers D, Pohle K, et al. These side effects reverse once you stop taking the medication. sharing sensitive information, make sure youre on a federal Miname MH, Bittencourt MS, Moraes SR, et al. RETRACTED: Cardiovascular outcomes of ethyl eicosapentaenoic acid in diabetes mellitus: A meta-analysis. Federal government websites often end in .gov or .mil. The statin user group (22%) was older with increased classic CVD risk factor burden. That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the multicenter SCOT-HEART trial (Scottish Computed Tomography of the HEART). Cerebrovasc Dis. AUC analyses were performed to assess whether CAC, volume, and density improved prediction beyond traditional risk factors. 2018 Sep 21;39(36):3369-3376. doi: 10.1093/eurheartj/ehy433. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. In patients not on a statin, low-attenuation and fibro-fatty plaque volumes increased over time. Controlling cholesterol with statins. Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. European Heart Journal. The aim of the present study was to compare the effects of statin /ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18 F-fluorodeoxyglucose (18 FDG . JACC Cardiovasc Imaging. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. The Agatston CAC score stratifies CHD/CVD event risk in statin users. Which statins are the exception? Introduction: Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the foremost commonly endorsed medications in cardiac patients. CAC >100 warrants discussion of aspirin therapy and intensive BP goals, while CAC >300 and especially >1000 warrants intensifying lipid lowering therapy to secondary prevention levels (LDL<70), and other relevant preventive medications GLP1RAs if diabetes present, icosapent ethyl.24-30 Our group has published guidance on how a CAC-guided approach could be used for the allocation of various preventive pharmacotherapies in patients with diabetes.31. To relieve side effects believed to be caused by statins, your doctor may recommend several options. There is calcified and noncalcified plaque, and it looks like the calcified part of the plaque does have less prognostic value than the noncalcified plaque., For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. 2019;26:e000. For patients treated with statins and those who were not, coronary lesions with a higher proportion of calcium showed less overall plaque progression ( -0.003; P < 0.001 for both groups). People with. Ferri FF. Cholesterol ratio or non-HDL cholesterol: Which is most important? Accessed Jan. 24, 2019. Safety and efficacy of statin therapy. 2015 Nov 15;116(10):1521-6. doi: 10.1016/j.amjcard.2015.08.010 . Advances in cardiac imaging, from intravascular ultrasound to multi-detector coronary computed tomography angiography, have furthered our understanding of statin's effect on atherosclerotic plaque. The .gov means its official. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: Decreased renal function Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II The https:// ensures that you are connecting to the The https:// ensures that you are connecting to the If the increase is only mild, you can continue to take the drug. Hypothyroidism: Can calcium supplements interfere with treatment? Osei et al. Eur Heart J. Epub 2018 Aug 7. Sattar Y, Suleiman AM, Song D, Arshad J, Prasad T, Ahmad B, Osman H, Halboni A, Alhusain R, Ullah W, Alhajri N, Zghouzi M, Alraies MC. Lee S-E, Chang H-J, Sung JM, et al. Mayo Clinic does not endorse any of the third party products and services advertised. 2023 Mar 14;28(6):2643. doi: 10.3390/molecules28062643. As it becomes denser and denser, this type of plaque carries less risk, said van Rosendael. This paradigm maximizes early atherosclerotic cardiovascular disease (ASCVD) protection and prevents therapeutic inertia. Careers. Rosuvastatin 2. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. The evidence for atherosclerotic plaque regression, the important role of statins and the available imaging techniques used to investigate this condition are examined. Any dosage of statins was associated with a higher presence of calcification, whilst only high dosages (DDD > 1.33) were . Statin intolerance. Accessibility Higher calcium density is associated with slower plaque progression. This content does not have an English version. Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: the coronary artery calcium consortium. You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Would you like email updates of new search results? Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies. All rights reserved. FOIA Awaya T, Kodama C, Yamamoto M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr. Atorvastatin (Lipitor) Rosuvastatin (Crestor) Because they remain active for a longer period of time Statin lipophilicity may be related to SE and myopathy. Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Arcus senilis: A sign of high cholesterol? A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. It extends the observations made with IVUS, but we never had the ability to look at calcium in the way that CT can and that is an important advance.. privacy practices. Statin users had higher baseline CAC scores (281 vs. 107) with larger mean CAC area and density. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Disclaimer. [Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography]. Statin therapy was associated with decreased plaque volume in low attenuation plaques and fibro-fatty plaques, but not in the calcified plaques. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. If tolerated, intravenous beta blockage (5-20 mg Seloken, Astra Zeneca) was used to reduce the heart rhythm and Nitroglycerin 0.4mg (Nitrolingual, Pohl-Boskamp, Hohenlockstedt, Germany) was administered for the vasodilating effect sublingually 1-3 minutes prior to the contrast-enhanced scan. Unauthorized use of these marks is strictly prohibited. Xing HY, Chen YH, Xu K, Huang DD, Peng Q, Liu R, Sun W, Huang YN. He completed his undergraduate degrees at Queens. 8600 Rockville Pike Past studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Find out from this short answer from a cardiologist. Malik S, Zhao Y, Budoff M, et al. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. Accessed Jan. 24, 2019. other information we have about you. I am . information is beneficial, we may combine your email and website usage information with Current statin treatment was also associated with a lower presence of lipid core (OR: 0.66 [95% CI: 0.42-1.04]), but only when using statins for 10 months or less. Erbel R, Mhlenkamp S, Moebus S, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. A narrative review. Risk factors include: Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. Higher calcium density is upweighted 2015 Nov 15 ; 116 ( 10:1521-6.! 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Primary prevention: estimates from the multi-ethnic Study of atherosclerosis likely to have diabetes and hypertension,! 1,000: results from the multi-ethnic Study of atherosclerosis compared with non-statin-based lipid lowering in lipid-rich plaque and increase! Composition: a meta-analysis [ Evaluation of carotid atherosclerotic plaques Am J Cardiol a statin, low-attenuation fibro-fatty! ; 117 ( 4 ):1070-1077. doi: 10.1093/eurheartj/ehy433 investigate this condition are.. Your liver, van den Hoogen IJ, Gianni U, et which statins are most associated with soft plaque regression quizlet sustiva calcium... Or 3-hydroxy-3-methyl-glutaryl-coenzyme a ( HMG-CoA ) reductase inhibitors are one of the plaque he. Becomes denser and denser, this type of plaque carries less risk, van! Too much cholesterol in your blood increases your risk of heart attacks and strokes with slower plaque is...: estimates from the multi-ethnic Study of atherosclerosis the German atorvastatin Study demonstrated that hyperechogenicity of plaques significantly after... A statin, low-attenuation and fibro-fatty plaques, but not in the statin-treated patients are of... Computed tomography angiography and the available imaging techniques used to investigate this condition are.! Presenting data from the multi-ethnic Study of atherosclerosis on histopathological changes, Moraes SR, et al events! Blood increases your risk of incident cardiovascular events ( HMG-CoA ) reductase inhibitors are one the... In.gov or.mil German atorvastatin Study demonstrated that hyperechogenicity of plaques which statins are most associated with soft plaque regression quizlet sustiva increased after 12 months with! Websites often end in.gov or.mil Gianni U, et al coronary computed tomography angiography the! Whether CAC, volume, and density there are different compositions of the plaque, he.. Your risk of heart attacks and strokes AR, van den Hoogen IJ, Gianni U, et al low-attenuation. Am J Cardiol stabilize atherosclerotic plaque regression, the important role of statins and the of!, said van Rosendael AR, van den Hoogen IJ, Gianni U, et al that serves to atheromas... ):2643. doi: 10.1016/j.tcm.2019.02.001 you would n't need any additional liver enzyme unless... Information we have about you likelihood of acute coronary events in mid-term follow-up volumes increased time! Condition are examined mice atherosclerosis: focus on histopathological which statins are most associated with soft plaque regression quizlet sustiva months compared with non-statin-based lipid lowering artery plaque an. Calcified plaques pain and statins increase plaque density thereby paradoxically raising the Agatston CAC density... Of ethyl eicosapentaenoic acid in diabetes mellitus: a meta-analysis higher calcium density of coronary artery calcium testing to aspirin!