Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

Gili, Sebastiano; Iannaccone, Mario; Colombo, Francesco; Montefusco, Antonio; Amabile, Nicolas; Calcagno, Simone; Capodanno, Davide; Scalone, Giancarla; Rognoni, Andrea; Omedè, Pierluigi; Ugo, Fabrizio; Cavallo, Erika; Mancone, Massimo; Mangiameli, A.; Boccuzzi, Giacomo; Hiansen, Joshua Qua; Motreff, Pascal; Toutouzas, Konstantinos; Garbo, Roberto; Sardella, Gennaro; Tamburino, Corrado; D’Amico, Maurizio; Moretti, Claudio; Templin, Christian; Gaïta, Fiorenzo; Souteyrand, Géraud; Niccoli, Giampaolo; D’Ascenzo, Fabrizio

doi:10.1093/ehjci/jex102

Cited by 36 publications

(25 citation statements)

References 26 publications

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“…In combination, these results suggested that hyperglycemia has a strong association with vulnerable plaque characteristics, namely, plaque rupture, lipid-rich plaque, and TCFA, regardless of DM status. It is worth mentioning that pretreatment with statin before acute coronary syndrome reduces not only the presentation of STEMI but also the prevalence of ruptured plaque and TCFA [24]. In the present study population, 18.7% of non-DM patients and 13.7% DM patients were on statin therapy before the index STEMI (p = 0:293).…”

Section: Culprit Lesion Characteristics In Nondiabetic Stemimentioning

confidence: 62%

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study

Zhou

Sheng

Liu

et al. 2020

Journal of Diabetes Research

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Background. Hyperglycemia is frequently observed in acute myocardial infarction (AMI). Diabetes mellitus (DM) patients and non-DM patients have different culprit lesion phenotypes and few data are available on non-DM patients with admission hyperglycemia. Therefore, we aimed to investigate the association between admission hyperglycemia and culprit lesion characteristics using optical coherence tomography (OCT) in AMI patients. Methods and Results. We consecutively enrolled 434 patients with AMI, and 277 patients were included in analysis: 65.7% (n=182) non-DM patients and 34.3% (n=95) DM patients. We measured acute blood glucose (ABG) and hemoglobin A1c to calculate the acute-to-chronic glycemic ratio (A/C). Then, we grouped non-DM patients into tertiles of A/C. OCT-based culprit lesion characteristics were compared across A/C tertiles in non-DM patients and between DM and non-DM patients. Non-DM patients had fewer lipid-rich plaques (52.7% versus 68.4%, p=0.012) and thin-cap fibroatheroma (TCFA) (19.8% versus 34.7%, p=0.006) than DM patients but similar prevalence of plaque rupture (47.3% versus 56.8%, p=0.130). Non-DM patients with the highest A/C tertile had the highest prevalence of plaque rupture (pfor trend=0.002), lipid-rich plaque (pfor trend=0.001), and TCFA (pfor trend=0.003). A/C>1.22 but not ABG>140 mg/dl predicted a high prevalence of plaque rupture, lipid-rich plaque, and TCFA in non-DM patients. Conclusions. In AMI patients without DM, admission hyperglycemia is associated with vulnerable culprit lesion characteristics, and A/C is a better predictor for vulnerable culprit plaque characteristics than ABG. These results call for a tailored evaluation and management of glucose metabolism in nondiabetic AMI patients. This trial is registered with NCT03593928.

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Section: Culprit Lesion Characteristics In Nondiabetic Stemimentioning

confidence: 62%

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study

Zhou

Sheng

Liu

et al. 2020

Journal of Diabetes Research

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“…Increased plaque instability may be the cause of the incidence of AF, together with smoking, drinking, and older age. Long-term treatment with statins is related to decreased occurrence of plaque rupture detected by OCT in patients presenting with ACS, with a potentially more marked effect in patients with NSTE-ACS [ 33 ]. Statins can enhance the production of endothelial-derived NO synthase, increase coronary blood flow, and reduce ischemia reperfusion injury.…”

Section: Discussionmentioning

confidence: 99%

Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China

et al. 2020

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“… 7 48–50 It has also been shown that accumulation of apo C-III and triglycerides in the necrotic core predisposes to plaque vulnerability in patients with stable CAD 51 ; hence, the significant lowering effect of fenofibrate on both of these parameters might justify its potential efficacy in preventing plaque rupture and acute CV events, as shown for statin therapy. 52 In addition, there is evidence in vivo showing the stabilising and regressing effects of fenofibrate 53 54 on the atherosclerotic plaque. It has been shown that elevated triglycerides and low HDL-C are not only associated with macrovascular atherosclerotic changes such as CAD, but they are also risk factors for microvascular disease in type 2 diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

Effect of fenofibrate on plasma apolipoprotein C-III levels: a systematic review and meta-analysis of randomised placebo-controlled trials

et al. 2018

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ObjectivesThis meta-analysis of randomised placebo-controlled clinical trials aimed to assess the effect of fenofibrate on apolipoprotein C-III (apo C-III), a key regulator of triglyceride metabolism.Materials and methodsRandomised placebo-controlled trials investigating the impact of fenofibrate treatment on apo C-III levels were searched in PubMed-Medline, Scopus, Web of Science and Google Scholar databases from inception to 18 August 2017. Quantitative data synthesis was determined by a random-effects model and generic inverse variance method. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate glycaemic parameter confounders.ResultsMeta-analysis of 10 clinical trials involving 477 subjects showed fenofibrate therapy decreased apo C-III levels (weighted mean difference (WMD) −4.78 mg/dL, 95% CI −6.95 to –2.61, p<0.001; I266.87%). Subgroup analysis showed that fenofibrate reduced plasma apo C-III concentrations in subgroups of trials with treatment durations of either <12 weeks (WMD −4.50 mg/dL, p=0.001) or ≥12 weeks (WMD: −4.73 mg/dL, p=0.009) and doses of fenofibrate <200 mg/day (WMD −6.33 mg/dL, p<0.001) and >200 mg/day (p=0.006), with no significant difference between the subgroups.ConclusionThis meta-analysis found that fenofibrate therapy significantly decreases apo C-III levels, an effect evident with both short-term treatment and doses less than 200 mg/day.

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Effects of statins on plaque rupture assessed by optical coherence tomography in patients presenting with acute coronary syndromes: insights from the optical coherence tomography (OCT)-FORMIDABLE registry

Abstract: Chronic pre-treatment with statins is associated with a reduced prevalence of ruptured plaques in patients presenting with ACS, particularly in those with NSTE-ACS. Statins bear hence the potential to reduce morbidity during the acute phase of ACS.

Cited by 36 publications

References 26 publications

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study

Association between Admission Hyperglycemia and Culprit Lesion Characteristics in Nondiabetic Patients with Acute Myocardial Infarction: An Intravascular Optical Coherence Tomography Study

Effect of 2 Different Dosages of Rosuvastatin on Prognosis of Acute Myocardial Infarction Patients with New-Onset Atrial Fibrillation in Jinan, China

Effect of fenofibrate on plasma apolipoprotein C-III levels: a systematic review and meta-analysis of randomised placebo-controlled trials

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