Otsuka F, Joner M, Prati F, Virmani R, Narula J. Careers. Given the similar improvement in prognostic value compared to risk factor only models (Table 2) and similar increases in absolute mortality rates, the attenuation of HR does not limit the clinical utility of using CAC scores for risk stratification in statin users.17. 2018 Sep 21;39(36):3369-3376. doi: 10.1093/eurheartj/ehy433. Clinical studies using ultrasound in the coronary arteries have shown that when you are on high doses of these medicines, even if you have plaque buildup already, you can stabilize the plaque on statin therapy. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. The aim of the present study was to compare the effects of statin /ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18 F-fluorodeoxyglucose (18 FDG . Before enriches our understanding about the role of CAC scores in statin users, a critical clinical and research question for preventive cardiology.18,19 Studies in cohorts with high rates of baseline statin use, e.g., populations with diabetes,20familial hypercholesterolemia,21,22 or patients with chest pain undergoing coronary computed tomography angiography (CCTA)23 suggest that CAC also stratifies risk of future events in these settings. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. Dizziness is commonly associated with statin use, possibly due to blood pressure-lowering effects. Diagnosis and management of statin intolerance. First, increases in Agatston CAC scores caused by statins are modest and therefore very elevated CAC scores, e.g., >400 or >1000, should still be interpreted as indicative of extensive atherosclerosis and trigger aggressive preventive pharmacologic management. Two statins in particular, atorvastatin, which is sold under the brand name Lipitor, and rosuvastatin, which is sold under the brand name Crestor, are the strongest statins. Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension, Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Plaque, Atherosclerotic, Acute Coronary Syndrome, Calcium, Coronary Artery Disease, Coronary Angiography, Computed Tomography Angiography, Body Mass Index, Selection Bias, Cardiovascular Diseases, Follow-Up Studies, Calcinosis, Ultrasonography, Atherosclerosis, Models, Statistical, Diabetes Mellitus, Risk Factors, Hypertension, Myocytes, Smooth Muscle, Cardiology, Life Style, Inflammation, Macrophages, Ultrasonography, Interventional, Risk Assessment, Lipids, Reference Standards, Cholesterol. The benefit of statins on exercise tolerance may be greater in patients with moderate-severe arterial stenosis (defined as an ABI <0.7) than in those with mild stenosis, which has been attributed to a possible regression and stability of the atheroma plaque in cases of more advanced atherosclerotic lesions with a higher lipid load on the plaque . Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the multicenter SCOT-HEART trial (Scottish Computed Tomography of the HEART). Nakazato R, Gransar H, Berman DS, et al. 2022 Feb 14;14(4):797. doi: 10.3390/nu14040797. We used logistic regression models to study the association of statin use with the presence of plaque components. Disclaimer. The statin user group (22%) was older with increased classic CVD risk factor burden. One of the most common complaints of people taking statins is muscle pain. Epub 2018 Aug 30. There is growing . Epub 2019 Feb 10. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. ](Source Hyperlinks https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117 ) JAMA Cardiol. Statins are effective at lowering cholesterol and protecting against a heart attack and stroke, although they may lead to side effects for some people. Even if your side effects are frustrating, don't stop taking your statin medication for any period of time without talking to your doctor first. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque, dubbed 1K plaque (> 1,000 Hounsfield units), was associated with a lower risk of ACS. The effect of CAC score on predictive value by AUROC are summarized in Table 2. Coronary calcium score and cardiovascular risk. The findings confirm that CAC does have prognostic value among statin users, although the association is attenuated. Budoff MJ, Young R, Burke G, et al. In contrast, statin therapy was associated with larger increases in high-density calcium volume and 1K plaque (both 0.02; P < 0.001). Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrao R.. Quantification of coronary artery calcium using ultrafast computed tomography. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Statins include atorvastatin (Lipitor), fluvastatin (Lescol XL), lovastatin (Altoprev), pitavastatin (Livalo), pravastatin (Pravachol), rosuvastatin (Crestor, Ezallor) and simvastatin (Zocor, FloLipid). Statin therapy appears to accelerate the process of transforming a potentially highly metabolically active plaque to a more inert state. Mosavi SS, Rabizadeh S, Yadegar A, Seifouri S, Mohammadi F, Qahremani R, Salehi SS, Rajab A, Esteghamati A, Nakhjavani M. BMC Complement Med Ther. I am . Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. Coronary atherosclerotic precursors of acute coronary syndromes. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. LDL stands for Low-Density Lipoprotein and is the type of cholesterol that gets deposited in your artery walls. Advertising revenue supports our not-for-profit mission. Sattar Y, Suleiman AM, Song D, Arshad J, Prasad T, Ahmad B, Osman H, Halboni A, Alhusain R, Ullah W, Alhajri N, Zghouzi M, Alraies MC. We discuss recent findings from a study by Osei et al. In patients treated with statin therapy, or other lipid-lowering agents, serially measuring CAC might reveal evidence of calcified plaque progression which does not reflect increased patient risk but rather a stabilization of the coronary plaque. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. Statin therapy leads to reduced plaque progression, likely representing a central mechanism for its favorable clinical effect. The progression of higher-density calcification was greater in statin-treated patients. All groups had statistically significant increases in plaque calcium indices from baseline; the increases ranged from 0.020 in the no-statin group to 0.038 in the low-intensity statin group to 0.044 in the high-intensity statin group. Statin-induced muscle syndromes. . Higher calcium density is associated with slowed plaque progression. Whats the Difference Between Good and Bad Cholesterol? Statin therapy was associated with decreased plaque volume in low attenuation plaques and fibro-fatty plaques, but not in the calcified plaques. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. HHS Vulnerability Disclosure, Help Rarely, if the increase is severe, you may need to try a different statin. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. 2019 Mar;26(4):365-379. doi: 10.1177/2047487318798059. A "nocebo" effect means people who have negative expectations about a medication report experiencing the potential side effect at higher rates than the drug should cause. Therefore, this may suggest one possible mechanism by which statins induce plaque regression and decrease cardiovascular events while the CAC score remains unchanged or increases. Nature Reviews Cardiology. Type 2 diabetes or high blood sugar. Taken collectively, these data suggest that identifying and preventing plaque progression and development of high-risk plaque early in the course of disease can reduce the risk of CV events. The new study, which was published last week in. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the. Coronary CTA has improved clinicians' ability to treat patients with coronary artery disease. Macroscopic calcification is uncommon in the early stages of atherosclerosis while its invariable presence during its later stages likely is related to decreasing inflammation and organization. Study limitations include the observational study design, lack of statin dosing information, and potential selection bias. Xing HY, Chen YH, Xu K, Huang DD, Peng Q, Liu R, Sun W, Huang YN. Calcium density of coronary artery plaque and risk of incident cardiovascular events. 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