Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Piña, Pamela; Lorenzatti, Daniel; Paula, Rita; Daich, Jonathan; Schenone, Aldo L.; Góngora, Carlos; García, Mario J.; Blaha, Michael J.; Budoff, Matthew J.; Berman, Daniel S.; Virani, Salim S.; Slipczuk, Leandro

doi:10.1016/j.ajpc.2022.100451

Cited by 5 publications

(16 citation statements)

References 158 publications

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“…Our findings suggest that biomarkers can help identify patients with HRP features, which previously was shown to increase risk of future events. 3,32 As lipid-lowering medicine has been associated with reduced progression of HRP features 33 , offering CCTA to patients with elevated TnI levels in stable chest pain patients may play an important role as it is unknown if all patients with elevated TnI or CRP will benefit from preventive therapy or only those with HRP or other adverse CAD features, Still, trials on biomarker-guided diagnostic testing and medical therapy in de novo stable chest pain patients are warranted.…”

Section: Discussionmentioning

confidence: 99%

Biomarkers for Identification of High-Risk Coronary Artery Plaques in Patients with Suspected Coronary Artery Disease

Pedersen,

Dahl,

Rasmussen

et al. 2023

Preprint

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Background: Patients with atherosclerotic plaques containing high-risk features have an increased likelihood of events and a worse prognosis. Whether increased levels of Troponin I (TnI) and C-reactive protein (CRP) are associated with the presence of high-risk coronary atherosclerotic plaques (HRP) is not well described. We assessed the association between 1) TnI and 2) CRP with quantified coronary plaque burden, luminal diameter stenosis, and HRP in patients with low/intermediate pre-test probability of obstructive coronary artery disease (CAD) referred for coronary computed tomography angiography (CCTA). Methods: The CCTA from 1,615 patients were analyzed using a semiautomatic software for coronary artery plaque characterization. Patients with high TnI (>6 ng/L) and high CRP (>2 mg/L) were identified. Associations of TnI and CRP with plaque burden, stenosis (?50% luminal diameter stenosis on CCTA), and HRP were investigated. Results: TnI and CRP were both positively correlated with total plaque burden (TnI rs=0.14, p<0.001; CRP rs=0.08, p<0.001). In multivariate logistic regression analyses, high TnI was associated with stenosis (OR 1.43, 95% confidence interval (CI) 1.03-1.99, p=0.034), the presence of HRP (OR 1.79, 95% CI: 1.17? 2.74, p=0.008), and the subtypes of HRP; low attenuation plaque (OR 1.93, 95% CI: 1.24?3.00, p=0.003), and positive remodeling (OR 1.51, 95% CI: 1.07?2.13, p=0.018). For CRP, only stenosis and napkin ring sign correlated significantly. Conclusion: In patients with suspected CAD, TnI and CRP are associated with HRP features. These findings may suggest that inflammatory and particularly ischemic biomarkers might improve early risk stratification and affect patient management. ClinicalTrials.gov identifier:NCT02264717

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Section: Discussionmentioning

confidence: 99%

Biomarkers for Identification of High-Risk Coronary Artery Plaques in Patients with Suspected Coronary Artery Disease

Pedersen,

Dahl,

Rasmussen

et al. 2023

Preprint

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“…Much of the evidence on the role of atherosclerotic burden as arguably the most important risk marker has come from CACS and CCTA studies. 8 – 10 …”

Section: Atherosclerotic Burden Versus Coronary St...mentioning

confidence: 99%

“…Given its wealth of evidence regarding risk stratification, low cost, and wide availability, CACS may be used in selected asymptomatic individuals to assess ASCVD risk. 9 The current debate revolves around the necessity for a new CAC score. There is a growing body of evidence suggesting that incorporating extra-coronary calcification, such as aortic valve, aortic, and mitral annular calcifications, may enhance risk prediction, especially for stroke and other cardiovascular outcomes.…”

Section: Atherosclerotic Burden Versus Coronary St...mentioning

confidence: 99%

“…By enhancing and refining CVD risk stratification, CACS may help guide lipid-lowering therapy for individuals in primary prevention. 9 In a large observational study of 13,644 patients without preexisting ASCVD followed for a median of 9 years, the effect of statin use on MACE was significantly related to the severity of CACS, with the number needed to treat (NNT) to prevent one initial MACE ranging from 100 (CACS 1–100) to 12 (CACS > 100). 39 Importantly, in patients with CACS = 0, statin therapy did not seem to affect the event rate.…”

Section: Using Cacs To Guide Lipid-lowering Therapymentioning

confidence: 99%

“…CACS = 0 appears to be the strongest negative predictor of ASCVD events when compared to other measures of subclinical CVD measures or biomarkers and allows downward reclassification (‘derisking’) of a substantial proportion of patients who are currently considered eligible for primary prevention with statin therapy. 48 For those with intermediate risk and CACS = 0, in the absence of high-risk features, it is reasonable to defer statin therapy 9 , 40 and reassess CACS in 3–5 years. 49 …”

Section: Using Cacs To Guide Lipid-lowering Therapymentioning

confidence: 99%

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Use of coronary artery calcium score and coronary CT angiography to guide cardiovascular prevention and treatment

Lima,

Lopes,

Ferreira

2024

Therapeutic Advances in Cardiovascular Disease

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Currently, cardiovascular risk stratification to guide preventive therapy relies on clinical scores based on cardiovascular risk factors. However, the discriminative power of these scores is relatively modest. The use of coronary artery calcium score (CACS) and coronary CT angiography (CCTA) has surfaced as methods for enhancing the estimation of risk and potentially providing insights for personalized treatment in individual patients. CACS improves overall cardiovascular risk prediction and may be used to improve the yield of statin therapy in primary prevention, and possibly identify patients with a favorable risk/benefit relationship for antiplatelet therapies. CCTA holds promise to guide anti-atherosclerotic therapies and to monitor individual response to these treatments by assessing individual plaque features, quantifying total plaque volume and composition, and assessing peri-coronary adipose tissue. In this review, we aim to summarize current evidence regarding the use of CACS and CCTA for guiding lipid-lowering and antiplatelet therapy and discuss the possibility of using plaque burden and plaque phenotyping to monitor response to anti-atherosclerotic therapies.

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Biomarkers for identification of high-risk coronary artery plaques in patients with suspected coronary artery disease

Pedersen,

Dahl,

Rasmussen

et al. 2024

Journal of Cardiovascular Computed Tomography

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Imaging subclinical coronary atherosclerosis to guide lipid management, are we there yet?

Cited by 5 publications

References 158 publications

Biomarkers for Identification of High-Risk Coronary Artery Plaques in Patients with Suspected Coronary Artery Disease

Biomarkers for Identification of High-Risk Coronary Artery Plaques in Patients with Suspected Coronary Artery Disease

Use of coronary artery calcium score and coronary CT angiography to guide cardiovascular prevention and treatment

Biomarkers for identification of high-risk coronary artery plaques in patients with suspected coronary artery disease

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