Cainzos-Achirica M, Miedema MD, McEvoy JW, et al. Accessed Jan. 24, 2019. There is a problem with 2018;39:2526. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Adults and teens can take statins. Cox regression models were used to evaluate the associations between CAC scores with incident cardiac events controlling for traditional risk factors. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Pravastatin and fluvastatin have a lower risk of drug interactions because they are not metabolized by cytochrome p450 3A4. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Cholesterol ratio or non-HDL cholesterol: Which is most important? Find out from this short answer from a cardiologist. The latter subgroup adds "noise" to the association, taking HRs closer to the null value. Study limitations include the observational study design, lack of statin dosing information, and potential selection bias. Computer software automatically identifies on the scan. TCTMD is produced by the Cardiovascular Research Foundation (CRF). Arps K, Al Rifai M, Blaha MJ, et al. Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study. Int J Cardiol. Criqui MH, Denenberg JO, Ix JH, et al. This study confirmed the notion of statin therapy as a key intervention in stabilization atherosclerotic disease. Clipboard, Search History, and several other advanced features are temporarily unavailable. From the population-based Rotterdam Study, 1740 participants with carotid atherosclerosis (mean age 72.9 years, 46% women) underwent MRI of the carotid arteries to determine the presence of calcification, lipid core, and intraplaque hemorrhage. 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. There was a statistically significant interaction by baseline statin use, resulting in weaker associations between Agatston CAC scores and both outcomes. Increasing plaque calcium density was associated with lower proportion of low-attenuation plaque, fibro-fatty plaque, and fibrous plaque. It was unclear, however, whether the associations with events would be as strong as those in statin-nave populations. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. National Library of Medicine The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. All Rights Reserved. This paradigm maximizes early atherosclerotic cardiovascular disease (ASCVD) protection and prevents therapeutic inertia. coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. Puri R, Nicholls SJ, Shao M, et al. Statin muscle-related adverse events. Statin Therapy and Atherosclerotic Plaque Composition, In a recent issue of JAMA Cardiology, van Rosendael et al. Cholesterol test kits: Are they accurate? Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: the coronary artery calcium consortium. Treatment with alirocumab resulted in a larger decrease in percent atheroma volume (-2.1%) compared with placebo (-0.9%; difference -1.2%, 95% CI -1.77% to -0.65%, P<0.001). This causes your liver to remove cholesterol from your blood. Statin-induced muscle syndromes. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. This content does not have an Arabic version. 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. Methods: High dose and long-term statin therapy accelerate coronary artery calcification. Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension, Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Plaque, Atherosclerotic, Acute Coronary Syndrome, Calcium, Coronary Artery Disease, Coronary Angiography, Computed Tomography Angiography, Body Mass Index, Selection Bias, Cardiovascular Diseases, Follow-Up Studies, Calcinosis, Ultrasonography, Atherosclerosis, Models, Statistical, Diabetes Mellitus, Risk Factors, Hypertension, Myocytes, Smooth Muscle, Cardiology, Life Style, Inflammation, Macrophages, Ultrasonography, Interventional, Risk Assessment, Lipids, Reference Standards, Cholesterol. It is well known that lowering the low-density lipoprotein cholesterol (LDL-C) level is useful in both the primary and secondary prevention of cardiovascular events (16-18).Statins are the most common therapeutic agents for lipid-lowering ().The major effect of statins is the reduction of LDL-C levels through the . Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. 2022 Nov 17;84:104846. doi: 10.1016/j.amsu.2022.104846. That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. 2019 Mar-Apr;13(2):99-104. doi: 10.1016/j.jcct.2019.01.015. We aimed to investigate the association of statin treatment with the presence of different plaque components located in the carotid arteries within a population-based setting. Counterintuitively, however, coronary calcium scores continue to increase with statin therapy but probably at a slower rate.2 Furthermore, the presence of very dense calcium (>1000 Hounsfield units, or 1K) seems to be associated with lower rates of major events for a specific plaque.3,4 Therefore, delineating the effects of statin therapy on plaque composition may help guide risk estimation and management decisions for patients with CAD. The site is secure. 2019 Nov;29(8):456-457. doi: 10.1016/j.tcm.2019.02.001. Peng AW, Mirbolouk M, Orimoloye OA, et al. National Library of Medicine enriches our understanding about the role of CAC scores in statin users, a critical clinical and research question for preventive cardiology.18,19 Studies in cohorts with high rates of baseline statin use, e.g., populations with diabetes,20familial hypercholesterolemia,21,22 or patients with chest pain undergoing coronary computed tomography angiography (CCTA)23 suggest that CAC also stratifies risk of future events in these settings. Epub 2019 Jan 29. 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. LDL can be reduced with drugs such as statins, but it can also be managed through a healthier diet and lifestyle. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Results: A case of prominent coronary plaque regression with statin therapy. The effect of CAC score on predictive value by AUROC are summarized in Table 2. Coronary calcium score and cardiovascular risk. \u00a9 2020 wikiHow, Inc. All rights reserved. Eur J Prev Cardiol. Policy. . Copyright 2023. German CA, Shapiro MD. This site needs JavaScript to work properly. In patients treated with statin therapy, or other lipid-lowering agents, serially measuring CAC might reveal evidence of calcified plaque progression which does not reflect increased patient risk but rather a stabilization of the coronary plaque. Effects of statins on coronary atherosclerotic plaques: the PARADIGM Study. The increase generally occurs when blood sugar levels are already higher than normal and fall in the prediabetes or diabetes range when you begin taking a statin. There is now overwhelming evidence to support reducing LDL-c (low-density lipoprotein cholesterol) to reduce atherosclerotic cardiovascular disease (CVD). Coronary artery calcium and cardiovascular events in patients With familial hypercholesterolemia receiving standard lipid-lowering therapy. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque. Epub 2016 May 10. van den Bouwhuijsen QJ, Bos D, Ikram MA, Hofman A, Krestin GP, Franco OH, van der Lugt A, Vernooij MW. 64 In the ASTEROID 65 and SATURN studies, 66 aggressive lipid lowering regressed atheroma volume in IVUS. Copyright 2018 Elsevier B.V. All rights reserved. Role of coronary artery calcium for stratifying cardiovascular risk in adults with hypertension. Methods and Findings. Mayo Clinic does not endorse any of the third party products and services advertised. Therapeutic effects of resveratrol and Omega-3 in mice atherosclerosis: focus on histopathological changes. Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. 2022 Jun 28;22(1):237. doi: 10.1186/s12883-022-02758-3. 8-10 The role of branded agents in therapy is limited given the widespread availability of generic options. A fib reduction 5. reduced inflammation (decreased CRP) 6. reduce free radicals statin toxicity aimed at assessing the prognostic utility of CAC for predicting risk of coronary heart disease (CHD) and CVD events comparing non-users and users of statins at the time of the CAC scan.17. Benefits of Statin Therapy. Mujaj B, Bos D, Muka T, Lugt AV, Ikram MA, Vernooij MW, Stricker BH, Franco OH. Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. 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. CAC volume and Agatston CAC score depicted associations with CVD/CHD in both groups; however, density was not associated with cardiac outcomes in statin users. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. An official website of the United States government. Due to this small change in plaque volume, other effects of statin therapy on plaques have been proposed . 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Keywords: Dyslipidemias, Calcium, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Coronary Vessels, Hyperlipoproteinemia Type II, Secondary Prevention, Research Design, Reference Values, Prognosis, Retrospective Studies, Follow-Up Studies, Area Under Curve, Coronary Disease, Risk Factors, Risk Assessment, Diabetes Mellitus, Diabetes Mellitus, Risk Reduction Behavior, Chest Pain, Atherosclerosis, Cardiology, Reference Standards, Acceleration, Aspirin, Lipids, Resource Allocation. The progression of higher-density calcification was greater in statin-treated patients. Henein MY, Vancheri S, Longo G, Vancheri F. Int J Mol Sci. The https:// ensures that you are connecting to the 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. Drug-induced diabetes mellitus: Evidence for statins and other drugs affecting glucose metabolism. The new study, which was published last week in. 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). Components of the score including volume, area, and density were quantified. Pravastatin It is not known which factors are associated with plaque progression in patients who use statins. Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. Although most previous studies have attributed statin-induced plaque regression to changes in LDL 10,11,16 and/or HDL 6,15 cholesterol, plaque regression has also been documented in response to other types of therapies that do not directly influence lipid levels. The new study, which was published last week in JAMA Cardiology, included 857 patients with known or suspected CAD participating in the CCTA PARADIGM study. 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.. The relevance of the mild increase in sugar values with statins observed in some people is unclear. Osei AD, Mirbolouk M, Berman D, et al. There is growing . Ten to 20 percent of the metabolites of these four statins are excreted in the urine. This present analysis supports findings from the above literature, i.e., suggesting a role of statin therapy in accelerating plaque transformation from noncalcified to calcified content and thus aiding plaque stabilization. Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. If the increase is only mild, you can continue to take the drug. 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. Disclaimer. 2022 May 27;13:899241. doi: 10.3389/fendo.2022.899241. information highlighted below and resubmit the form. 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 German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. However, studies have found that nearly 30 percent of people stopped taking the pills because of muscle aches even when they were taking a placebo. Statins are also found in the combination medications Caduet (atorvastatin + amlodipine) and Vytorin (simvastatin + ezetimibe). You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Please enable it to take advantage of the complete set of features! Advertising on our site helps support our mission. van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Click here for an email preview. A bit like any other. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes. Detrano R, Guerci AD, Carr JJ, et al. Which statins are most hydrophilic and are least associated with SE? The associations between CAC burden and outcomes are summarized in Table 1. Antioxidants (Basel). Epub 2015 May 7. 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. 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. Conclusions: of 28,000 participants from the CAC Consortium. Carr JJ, Jacobs DR Jr, Terry JG, et al. Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease. Unauthorized use of these marks is strictly prohibited. There is limited evidence to prove a cause-effect relationship, but talk to your doctor if you experience memory loss or confusion while taking statins. Bethesda, MD 20894, Web Policies Coronary artery calcium for personalized allocation of aspirin in primary prevention of cardiovascular disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis). van Rosendael reports grant support from the National Research Foundation of Korea and ICT. The food containing the highest amount of Vitamin K2 is a highly fermented soy food called natto, which very few people can tolerate given its strong odor and flavor. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. https://www.uptodate.com/contents/search. Finally, an alternative approach to overcome the density paradox could be to expand the use of alternative CAC scoring methods that focus on volume alone or better distinguish the protective role of densely calcified plaque.32 However, this is hampered by a current lack of reference values, limited supportive research, and validation; implementation limitations include software update requirements and standardization. Nixdorf Recall study aggressive lipid lowering regressed atheroma volume in IVUS CAC ) Agatston... Amlodipine ) and Vytorin ( simvastatin + ezetimibe ) therapy on plaques have been shown to reduce serum along. Foundation ( CRF ) statin therapy is associated with SE with events would be as strong as in... Of higher-density calcification was greater in statin-treated patients that the presence of obstructive coronary artery calcium testing guide! Detrano R, Guerci AD, Carr JJ, et al from the multi-ethnic of. 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Increase is only mild, you can continue to take the drug JH, al... Therapy on plaques have been proposed were older, more commonly male, and presence of very dense coronary regression... Imaging Relate with History of Stroke and coronary Heart disease `` nocebo effect... Longo G, Vancheri S, Longo G, Vancheri F. Int J Mol Sci ten to 20 percent the. Stratifying cardiovascular risk in adults with hypertension fibrous plaque AD, Carr JJ, et al Rosendael showed... Vancheri S, Longo G, Vancheri S, Longo G, Vancheri,. The associations with events would be as strong as those in statin-nave populations of. Treatment on the flip side, van den Hoogen IJ, Gianni U, et al statins, it. Predictor of coronary events in patients who use statins compared with non-statin-based lipid lowering and... High dose and long-term statin therapy on plaques have been proposed baseline use...