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

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.

Implications of serial coronary computed tomography angiography in the evaluation of coronary plaque progression

“…The article, based on PARADIGM study data, showed that in the nonstatin group, coronary ACS increase was positively associated with both noncalcified and calcified plaque volume increase. However, in the statin-taking group, coronary ACS increase was positively associated with calcified plaque volume change but was negatively associated with noncalcified plaque volume change [32].…”

Pharmacological Primary Cardiovascular Prevention and Subclinical Atherosclerosis in Men: Evidence from the Aragon Workers’ Health Study

“…Another factor associated with the presence of atherosclerosis, and in particular a CACS > 0, was previous treatment with statins. This finding is unsurprising, as treatment with statins has been associated with both the regression of non-calcified atherosclerotic lesions and the progression of CACS [ 22 ]. The most common lipid-lowering therapy, statin treatment, has been identified as the factor that most influenced cardiovascular disease prevention and regression of atherosclerosis [ 23 ].…”

Atherogenic index of plasma and coronary artery calcification progression beyond traditional risk factors according to baseline coronary artery calcium score

“…Because the present study only evaluated the change in CACS in the asymptomatic adult population, data on changes in the regional distribution or pattern of CAC were unavailable. In addition, the effect of medications such as statins, which could influence the changes in plaque sub-types, was not considered 26 . However, a recent CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) sub-study found that further prognostic benefit was not offered by coronary computed tomographic angiography (CCTA) findings when added to traditional risk factors and CACS in 1,226 asymptomatic participants, during a mean 5.9 ± 1.2 years of follow-up 27 .…”