Influence of a Lipid-Lowering Therapy on Calcified and Noncalcified Coronary Plaques Monitored by Multislice Detector Computed Tomography

Abstract

Statin therapy led to a significant reduction of noncalcified plaque burden that was not reflected in calcium scoring or total plaque burden. This finding might explain the risk reduction after the initiation of statin therapy. Using multislice detector computed tomography, physicians have the potential to monitor medical treatment in patients with coronary atherosclerosis.

Effect of Eicosapentaenoic and Docosahexaenoic Acids Added to Statin Therapy on Coronary Artery Plaque in Patients With Coronary Artery Disease: A Randomized Clinical Trial

“…Given that biological mechanisms for formation of fatty and fibrous plaque may differ, prespecified secondary outcomes included assessing changes in fatty and fibrous plaques individually as well as calcified and total plaque volumes. Sample size for the primary outcome was estimated based on data from the single longitudinal CCTA study at the time showing a mean (SD) 24% (13%) reduction in coronary plaque volume with statin treatment in 27 patients 9. Given the lack of data on the effect of omega‐3 fatty acid on coronary plaque, we powered the study to detect a 4% reduction (one sixth that of statins) in plaque volume in the omega‐3 ethyl‐ester group compared with no change in controls.…”

“…We chose CCTA because it is noninvasive, allows for examination of all coronary arteries in contrast to intravascular ultrasound, which examines only a culprit artery, and has been validated to detect progression of coronary plaque volume 5, 6, 7, 8. Moreover, CCTA has shown attenuation of progression of coronary plaque by statin drugs 9, 10, 11, 12, 13…”

Rationale and design of the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry: A comprehensive exploration of plaque progression and its impact on clinical outcomes from a multicenter serial coronary computed tomographic angiography study

“…26,27,33,45 Still, there is limited data regarding plaque progression using CCTA. Although some papers have used serial CCTA findings to describe the progression or change in coronary plaques, 33,[45][46][47][48][49][50][51] research to date has been limited by a small study sample, relatively short time of interval between the scans, as well as focus on a specific subset of patients or lesions. Also, these studies have primarily focused on high-risk populations (TABLE 2).…”

Coronary Artery Disease Progression: Insights from Cardiac CT

“…Our group previously [57] evaluated 100 patients who had CTA for evaluation of CAD, and found that the total progression was significantly reduced among statin users, with significantly reduced progression of non-calcified plaque volume and low attenuation plaque volume, with no significant changes in calcified plaque. Burgstahler et al [58] reported findings from the New AGE II Pilot Study of 46 men with established coronary artery disease after a year of 20 mg of atorvastatin that showed significant reduction of noncalcified plaque burden, however no reduction in total plaque burden or coronary calcium score on follow-up. Inoue et al [59] used CTA to assess the effect of fluvastatin treatment on 24 patients who received the statin after a baseline scan versus 8 subjects who refused treatment, and reported a significantly greater plaque volume change in statin versus control group that was due mostly to a reduction in low attenuation plaque, with no significant difference in lumen volume and remodeling index between the two groups.…”