Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease

Hwang, Ingyu; Jeon, Joo Yeong; Kim, Younhee; Kim, Hyue Mee; Yoon, Yeon Yee; Lee, Seung–Pyo; Kim, Yong Jin; Sung, Jidong; Kim, Yong-Jin

doi:10.1016/j.atherosclerosis.2015.01.036

Cited by 50 publications

(35 citation statements)

References 32 publications

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“…In 2 observational studies, it was demonstrated that patients with CAD on coronary computed tomographic angiography who were on statin therapy demonstrated better prognosis than patients who were not on statin therapy. 27,28 In a randomized controlled trial, a trend toward reduction of cardiovascular events was observed in patients with CAC scores >400 who were treated with statins in combination with antioxidant vitamins. 29 Although our study reflects true daily practice and included consecutive patients, we have to acknowledge several limitations.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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Background— The prognostic value of coronary artery calcium (CAC) scoring on top of myocardial perfusion imaging with single-photon emission computed tomography (SPECT) in patients suspected for coronary artery disease is not well established. Methods and Results— Four thousand eight hundred ninety-seven symptomatic patients without a history of coronary artery disease referred for SPECT and CAC scoring were included. Major adverse cardiac events (MACEs) were defined as late revascularization (>90 days after scanning), nonfatal myocardial infarction, and all-cause mortality. The frequency of abnormal SPECT increased with higher CAC scores, from 12% in patients with CAC scores of 0 to 19%, 32%, 37%, and 50% among those with CAC scores 1 to 99, 100 to 399, 400 to 999, and ≥1000, respectively ( P <0.001). During a median follow-up of 940 days (25th to 75th percentile, 581–1377), a total of 278 MACEs were observed. Overall incidence of MACE was 2.3% per year. A stepwise increase of MACE was present with increasing CAC scores, both in patients with normal SPECT (annual event rate CAC score 0: 0.6%; CAC score ≥1000: 5.5%) and abnormal SPECT (annual event rate CAC score 0: 0.4%; CAC score ≥1000: 7.6%). After multivariate analysis, both SPECT and CAC score were independent predictors of MACE (CAC score ≥1000: hazard ratio, 7.7; P <0.001 and large perfusion defect on SPECT: hazard ratio, 3.7; P <0.001). Conclusions— CAC score and SPECT are independent predictors of MACE in patients suspected for coronary artery disease. Our findings strongly support performing a CAC score in addition to SPECT in symptomatic patients to better define the risk of events during follow-up.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Engbers

Timmer

Ottervanger

et al. 2016

Circ: Cardiovascular Imaging

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“…This is despite the available evidence suggesting that individuals with nonobstructive CAD have an increased risk for adverse clinical outcomes compared with patients with normal coronary arteries 4, 7, 8. Moreover, there is evidence that medical therapy (in particular, aspirin and statins) improves clinical outcomes in patients with nonobstructive CAD 17, 18. Consistent with this, we found important differences in clinical outcomes in patients receiving OMT, particularly being at lower risk for all‐cause hospitalization compared with those who were not receiving OMT.…”

Section: Discussionmentioning

confidence: 99%

Variations in Use of Optimal Medical Therapy in Patients With Nonobstructive Coronary Artery Disease: A Population‐Based Study

Oxner

Elbaz‐Greener

Qui

et al. 2017

JAHA

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BackgroundThere is a paucity of data on the need for optimal medical therapy (OMT) in nonobstructive coronary artery disease . We sought to understand if there was variation in the use of OMT between hospitals for patients with nonobstructive coronary artery disease, the factors associated with such variation, and its clinical consequences.Methods and ResultsUsing a population‐level clinical registry in Ontario, Canada, we identified all patients >66 years undergoing coronary angiography for the indication of stable angina, who had nonobstructive coronary artery disease between November 1, 2010, and October 31, 2013. Hierarchical multivariable logistic models were developed to identify the factors associated with OMT use, with median odds ratio used to quantify the degree of variation between hospitals not explained by the modeled risk factors. Clinical outcomes of interest were all‐cause mortality and rehospitalization, with follow‐up until March 31, 2015. Our cohort consisted of 5413 patients, of whom 2554 (47.2%) were receiving OMT within 1 year. There was a 2‐fold variation in OMT across hospitals (30.4%–61.8%). The variation between hospitals was fully explained by preangiography medication use (median odds ratio of 1.21 in the null model and 1.03 in the full model). There was no difference in risk‐adjusted mortality (hazard ratio, 0.94; 95% confidence interval, 0.76–1.16); however, patients receiving OMT had a lower risk of all‐cause hospital readmission (hazard ratio, 0.89; 95% confidence interval, 0.84–0.95).ConclusionsThere is wide variation in the use of OMT in patients with nonobstructive coronary artery disease, the major driver of which is differences in baseline medication use.

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“…Besides having a lipidlowering effect, a statin is associated with a reduction in all causes of death from non-obstructive coronary artery disease [4]. Additionally, some authors have found it to have a positive effect on vascular inflammation [5], and linked it to a lower risk of developing venous thromboembolism [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of alpha-tocopherol associated with lovastatin on brain tissue and memory function in SHRSPs

Guimarães

Murad

Paganelli

et al. 2015

Physiology & Behavior

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Strokes are preceded by oxidative stress and inflammation, two processes linked to atherosclerosis and hypertension. Statins have been widely employed to control atherosclerosis; however, there could be neurological implications to its use—including cognitive impairment. Thus,we aimed to determine whether alpha-tocopherol is capable of reversing the neurological side effects of statins and enhancing its anti-inflammatory properties. To assess these effects, 15-week-old stroke-prone spontaneously hypertensive rats (SHRSPs) were divided into four groups (n = 6, each): alpha-tocopherol (AT), lovastatin (LoV), alpha-tocopherol + lovastatin (AT + LoV), and control (C).We administered 120 IU of alpha-tocopherol diluted in 0.1 ml of coconut oil,whereas the dose of lovastatin was administered at a ratio of 1 mg/kg of rat body weight. The control group received 0.1 ml coconut oil. All animals received the treatments via orogastric gavage.We assessed body weight, diuresis, food and water intake, oxidative stress (malondialdehyde levels), the total cellular injury marker (lactate dehydrogenase), short and long-term memory, cognition, and histopathological changes in the hippocampus. The results demonstrated that lovastatin treatment did not negatively affect the memory of our animal model. In fact, the animals treated with AT and LoV showed improvement in memory and cognition. Additionally, both treatments decrease lactate dehydrogenase and oxidative stress levels. Furthermore, our study also demonstrated hippocampal tissue preservation in the treated groups.

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Statin therapy is associated with lower all-cause mortality in patients with non-obstructive coronary artery disease

Cited by 50 publications

References 32 publications

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Prognostic Value of Coronary Artery Calcium Scoring in Addition to Single-Photon Emission Computed Tomographic Myocardial Perfusion Imaging in Symptomatic Patients

Variations in Use of Optimal Medical Therapy in Patients With Nonobstructive Coronary Artery Disease: A Population‐Based Study

Effects of alpha-tocopherol associated with lovastatin on brain tissue and memory function in SHRSPs

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