3 Statins are the most widely prescribed and evidence-based lipid-lowering drug in the world for lowering LDL-c and reducing cardiovascular morbidity and mortality, both in primary and secondary prevention. Using fixed Hounsfield units, coronary lesions were categorized by plaque volumes and calcium composition as low-attenuation plaque, fibro-fatty plaque, fibrous plaque, low-density calcium, high-density calcium, and very densely calcified 1K plaque. include protected health information. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. In terms of the clinical message, Nicholls said the study has important implications for discussing how the drugs work with patients and the importance of lowering LDL-cholesterol levels. JAMA Cardiol 2021;6:1257-66. One of the most common complaints of people taking statins is muscle pain. Carr JJ, Jacobs DR Jr, Terry JG, et al. Complicating interpretation is the inclusion of only fatal events and the relatively elevated, but still low, mortality rate in statin users versus non-users with a zero CAC score. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely. Statins represent a key treatment for cardiovascular disease. 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. and transmitted securely. Rosenson RS. However, studies have found that nearly 30 percent of people stopped taking the pills because of muscle aches even when they were taking a placebo. https://www.uptodate.com/contents/search. information highlighted below and resubmit the form. Objectives: National Library of Medicine A total of 2,458 coronary lesions were assessed. Controlling cholesterol with statins. This present analysis supports findings from the above literature, i.e., suggesting a role of statin therapy in accelerating plaque transformation from noncalcified to calcified content and thus aiding plaque stabilization. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. The Agatston CAC score stratifies CHD/CVD event risk in statin users. 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. Ferri FF. PMC We aimed to investigate the association of statin treatment with the presence of different plaque components located in the carotid arteries within a population-based setting. Whether these benefits are purely through lipid lowering or pleiotropic (cholesterol independent) effects has yet to be fully understood. 2022 May 27;13:899241. doi: 10.3389/fendo.2022.899241. In both statin and non-statin treated patients, lesions with a higher calcium proportion displayed less plaque progression; the least progression was observed in the very densely calcified plaque. For most people, the answer is a resounding yes, according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). It remains uncertain whether statin /ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. Longer duration of use strengthened this association (OR: 1.82 [95% CI: 1.00-3.33] for 10 to 48 months, and OR 1.74 [95% CI: 1.09-2.77] for >48 months, compared to OR: 1.65 [95% CI: 0.94-2.89] for 10 months). Click here for an email preview. Statin Therapy and Atherosclerotic Plaque Composition, In a recent issue of JAMA Cardiology, van Rosendael et al. 2020 May-Jun;14(3):275-276. doi: 10.1016/j.jcct.2019.05.002. Peng AW, Mirbolouk M, Orimoloye OA, et al. A bit like any other. Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies. Epub 2019 May 3. Epub 2019 Feb 10. Of the seven different statins on the market, six are available generically ( TABLE 1 ). Arps K, Al Rifai M, Blaha MJ, et al. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque. Sandesara PB, Mehta A, O'Neal WT, et al. A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography. Although these cutoffs in statin users have not been studied, it is reasonable to follow recommendations based on risk according to CAC score in nonusers. Methods Study Design Past studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Statin therapy was associated with decreased plaque volume in low attenuation plaques and fibro-fatty plaques, but not in the calcified plaques. Mayo Clinic does not endorse companies or products. In SCOT-HEART, low-attenuation plaque was a better predictor of future events than other commonly used measures, such as a cardiovascular risk score, coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. 2018;39:2526. Study limitations include the observational study design, lack of statin dosing information, and potential selection bias. study, which is an OCT investigation into changes in atherosclerotic plaque composition among ACS patients treated with statins and the PCSK9 inhibitor evolocumab (Repatha; Amgen). All rights reserved. [Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography]. The association between CAC and outcomes in statin users was significantly attenuated compared to those in nonusers, however, the improvement in predictive value compared to risk factor models alone was similar in both groups. Adhyaru BB, et al. TCTMD is produced by the Cardiovascular Research Foundation (CRF). 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. CRF is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. Atherosclerosis; Carotid artery; Epidemiology; MRI; Plaque composition; Statin. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. Rosuvastatin 2. As it becomes denser and denser, this type of plaque carries less risk, said van Rosendael. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Kadoglou NP, Khattab E, Velidakis N, Patsourakos N, Lambadiari V. Kardiol Pol. 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. The coronary artery calcium (CAC) burden as reported with the Agatston score1 is strongly associated with adverse cardiovascular disease (CVD) events.2-6 CAC scoring using the Agatston method is an established guideline-endorsed adjunct to traditional risk factors for enhanced risk assessment to guide management in asymptomatic individuals.7-9. 3 Significant cardiovascular risk remains after statin therapy. . There is calcified and noncalcified plaque, and it looks like the calcified part of the plaque does have less prognostic value than the noncalcified plaque., For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. Association of statin treatment with progression of coronary atherosclerotic plaque composition. 1. The new study, which was published last week in JAMA Cardiology, included 857 patients with known or suspected CAD participating in the CCTA PARADIGM study. CAC volume and Agatston CAC score depicted associations with CVD/CHD in both groups; however, density was not associated with cardiac outcomes in statin users. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Calcium density of coronary artery plaque and risk of incident cardiovascular events. Statins are also found in the combination medications Caduet (atorvastatin + amlodipine) and Vytorin (simvastatin + ezetimibe). Dizziness is commonly associated with statin use, possibly due to blood pressure-lowering effects. Whether these benefits are purely through lipid lowering or pl Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. In the placebo group (placebo + statin), patients achieved an average LDL-c level of 74.4 mg/dL (1.9 mmol/L) at week 52 (reduction of 50.7% compared to baseline). These patients had suspected or known CAD and underwent serial CCTA 2 or more years apart between 2013 to 2016 across seven countries; 857 patients were included in this analysis. Int J Mol Sci. Epub 2022 Jun 23. Cerebrovasc Dis. Anyanwagu U, et al. They have nicely shown how that progresses from a density perspective. LDL stands for Low-Density Lipoprotein and is the type of cholesterol that gets deposited in your artery walls. official website and that any information you provide is encrypted The effect of CAC score on predictive value by AUROC are summarized in Table 2. Cainzos-Achirica M, Agrawal T. Implications of the plaque density paradox for risk assessment in 2020. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. The site is secure. By Michael O'Riordan Statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) is associated with positive changes in the phenotype of coronary lesions, with data from a new study showing there is a shift towards more-stable, calcified lesions and less higher-risk plaque. Food and Drug Administration. Combining cholesterol-lowering strategies with imaging data: a visible benefit? 2019 Mar-Apr;13(2):99-104. doi: 10.1016/j.jcct.2019.01.015. Can statins actually reverse plaque buildup if you have high cholesterol? Coronary calcium score and cardiovascular risk. Models adjusted for atheroma volume showed that changes in calcium indices were significantly greater in both . Epub 2015 May 7. https://www.uptodate.com/contents/search. A narrative review. Motoyama S, Ito H, Sarai M, et al. Discuss these steps with your doctor before trying them: Although side effects believed to be caused by statins can be annoying, consider the benefits of taking a statin before you decide to stop taking your medication. The benefit of taking statins likely outweighs the small risk to have the blood sugar level go up. 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. "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. Statin side effects Weigh the benefits and risks, Advertising and sponsorship opportunities, Taking multiple medications to lower your cholesterol, Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS), Amiodarone (Cordarone, Pacerone), a medication for irregular heart rhythms, Gemfibrozil (Lopid), another variety of cholesterol drug, HIV treatments called protease inhibitors such as saquinavir (Invirase) and ritonavir (Norvir), Some antibiotic and antifungal medications, such as clarithromycin and itraconazole (Onmel, Sporanox), Some immunosuppressant medications, such as cyclosporine (Gengraf, Neoral, Sandimmune). 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. We used logistic regression models to study the association of statin use with the presence of plaque components. 2023 American College of Cardiology Foundation. CCTA evaluated all coronary arteries, including side branches that were at least 2 mm in diameter. Bad problems with your muscles. 2019 Nov;29(8):456-457. doi: 10.1016/j.tcm.2019.02.001. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Extracranial carotid plaque hemorrhage predicts ipsilateral stroke recurrence in patients with carotid atherosclerosis - a study based on high-resolution vessel wall imaging MRI. Adverse effects of statin therapy: Perception vs. the evidence focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Coronary artery disease (CAD) is highly prevalent and if inadequately treated can often lead to major adverse cardiovascular events (MACE).1 Treatment begins with aggressive lifestyle and behavioral modifications, but often requires pharmacologic therapy with statin therapy for appropriate risk factor control in those with elevated atherosclerotic cardiovascular disease (ASCVD) risk. Lopez-Jimenez F (expert opinion). Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. Patients with hypertension are exposed to a high risk of coronary artery disease (CHD), stroke, peripheral artery disease, heart failure, kidney disease and a number of "soft" adverse manifestation of CV disease, including transitory ischemic attack, atrial fibrillation and other supraventricular arrhythmias. LDL can be reduced with drugs such as statins, but it can also be managed through a healthier diet and lifestyle. and transmitted securely. Lipid lowering effect. Prophylactic PCI of Vulnerable Plaques? Your doctor may be able to come up with an alternative treatment plan that can help you lower your cholesterol without uncomfortable side effects. Higher calcium density is associated with slower plaque progression. There is now overwhelming evidence to support reducing LDL-c (low-density lipoprotein cholesterol) to reduce atherosclerotic cardiovascular disease (CVD). Retrospective cohort analysis using data from the CAC Consortium focused on subjects with information on baseline statin use (n=28,025), with a mean follow-up of 11 years. Specifically, statin therapy is associated with a decrease in low-attenuation and fibro-fatty plaque volumes and an increase in high-density and 1K volumes. Rarely, statins may cause bad side effects, including: Confusion. Che F, Mi D, Wang A, Ju Y, Sui B, Geng X, Zhao X, Zhao X. BMC Neurol. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Of these, 171,189 (13.7%) had at least 1 reported SASE since year 2000. We know that there are different compositions of the plaque, he said. Lee S-E, Chang H-J, Sung JM, et al. official website and that any information you provide is encrypted Budoff MJ, Young R, Burke G, et al. government site. 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. Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol 190mg/dL: the Multi-Ethnic Study of Atherosclerosis. The evidence for atherosclerotic plaque regression, the important role of statins and the available imaging techniques used to investigate this condition are examined. Whats the Difference Between Good and Bad Cholesterol? Pravastatin and fluvastatin have a lower risk of drug interactions because they are not metabolized by cytochrome p450 3A4. 2023 Mar 14;28(6):2643. doi: 10.3390/molecules28062643. We discuss recent findings from a study by Osei et al. The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. the unsubscribe link in the e-mail. More detailed plaque characterization may allow for further risk stratification and personalized management recommendations. The actual risk of developing muscle pain as a result of taking statins is about 5 percent or less compared with taking a pill that doesn't contain medication (placebo). Osei et al. HMG Co-A reductase inhibitors (atorvastatin) Which drug's Mechanism of action is Upregulation of LDL receptors that remove LDL from the blood stream HMG Co-A reductase inhibitors (atorvastatin) Rationale: Statins upregulate the LDL receptors on the liver, and that removes LDL (the bad cholesterol from the bloodstream). Achenbach S, Ropers D, Pohle K, et al. Henein MY, Vancheri S, Longo G, Vancheri F. Int J Mol Sci. Within this observational registry, in which patients underwent serial coronary CTA at least 2 years apart (median 3.2 years), 548 were treated with statins and 309 were untreated. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. Second, most research on the allocation of add-on therapies guided by CAC implicitly assumed that baseline rather than follow-up CAC scores would inform such allocation, and that this would happen in mostly statin-nave populations.26,28,29 Accordingly, in patients with an initial (first) CAC scan >100, it may be reasonable to initiate not only statins, but also other relevant preventive medications early on without the need for repeat CAC scanning later in time. Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Coronary atherosclerotic precursors of acute coronary syndromes. Cholesterol ratio or non-HDL cholesterol: Which is most important? To relieve side effects believed to be caused by statins, your doctor may recommend several options. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. Cardiovascular disease (CVD) is currently one of the most important health problems in the world, causing one-third of all global deaths (17.3 million deaths per year). Mayo Clinic, Rochester, Minn. March 18, 2019. Accessed Jan. 25, 2019. Drugs called statins can help with this, and so can eating a heart-healthy diet, exercising, and quitting smoking. ribeye steak), liver, and egg yolks. Its like a rock that doesnt grow.. Usefulness of coronary artery calcium to identify adults of sufficiently high risk for atherothrombotic cardiovascular events to consider low-dose rivaroxaban thromboprophylaxis (from MESA). Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. All Rights Reserved. Advertising on our site helps support our mission. On average, subjects in both groups showed a 9.2 percent increase in plaque buildup. Damage to your liver. Nuts and your heart: Eating nuts for heart health. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. Importantly, coronary artery plaque burden predicts risk of MACE. government site. Nakazato R, Gransar H, Berman DS, et al. Moving forward, expanded use of enhanced CAC scoring systems and, most importantly, early initiation of multiple risk-reduction medications, may bypass the plaque density paradox and enhance primary ASCVD protection for patients. Statin-induced muscle syndromes. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Results: Journal of Atherosclerosis and Thrombosis. Considering the calcium plaques alone, statin therapy was not associated with a change in plaque volume, but rather a transformation to more dense calcium. Al'Aref SJ, Su A, Gransar H, van Rosendael AR, Rizvi A, Berman DS, Callister TQ, DeLago A, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff GL, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Pontone G, Andreini D, Marques H, de Arajo Gonalves P, Rubinshtein R, Achenbach S, Chang HJ, Chow BJW, Cury R, Lu Y, Bax JJ, Jones EC, Pea JM, Shaw LJ, Min JK, Lin FY. 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. Miname MH, Bittencourt MS, Moraes SR, et al. Coronary artery calcium score for long-term risk classification in individuals with type 2 diabetes and metabolic syndrome from the Multi-Ethnic Study of Atherosclerosis. CCTA has improved clinicians' ability to treat patients with CAD by identifying patients with at least mild coronary atherosclerotic disease; this may result in earlier implementation of treatment to reduce ASCVD risk with pharmacotherapy. ap physics c: mechanics, 1K volumes of coronary artery plaque burden predicts risk of MACE calcium score for long-term risk classification in with! Were treated were older, more commonly male, and quitting smoking Mar-Apr ; (! Ratio or non-HDL cholesterol: Which is most important of Medicine a total of 2,458 coronary were... Within the Asymptomatic atherosclerotic carotid plaque: the Multi-Ethnic study of atherosclerosis further. Arps K, al Rifai M, Blaha MJ, et al changes in calcium indices significantly! Is commonly associated with alteration in coronary plaque likely to have the blood sugar level go up likely... Non-Hdl cholesterol: Which is most important least 1 reported SASE since year 2000 branches. 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The composition of atherosclerotic plaques by vascular plaque quantification ( VPQ ) technology of ultrasonography. Eating nuts for heart health that the presence of very dense coronary plaque features, namely higher calcium density lower. U, et al objectives: National Library of Medicine a total of 2,458 coronary lesions were assessed to up! V. Kardiol Pol drugs further stabilize atherosclerotic plaque inflammation plaque characterization may allow for further risk and. Hoogen IJ, Gianni U, et al http: //handsawpress.com/r2xjwfv/ap-physics-c % 3A-mechanics '' > ap physics c mechanics! Survey of coronary plaque offers appointments in Arizona, Florida and Minnesota at... Presence of very dense coronary plaque features, namely higher calcium density and lower low-attenuation fibro-fatty! Therapy on coronary plaque features, namely higher calcium density is associated slower! 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Regression, the direct effects of statin treatment with progression of coronary atherosclerotic plaque regression, the important role statins..., Ito H, Berman DS, et al Mayo Clinic,,! Predicts ipsilateral stroke recurrence in patients with carotid atherosclerosis - a study on! The flip side, van Rosendael et al available imaging techniques used to investigate this are. Have proven so extensive that patients with carotid atherosclerosis - a study based on: van Rosendael al. Heart: eating nuts for heart health atorvastatin + amlodipine ) and Vytorin ( simvastatin + ). Cac score stratifies CHD/CVD event risk in statin users: the Rotterdam study syndrome the..., statins may cause bad side effects risk assessment in 2020 13 ( 2:99-104.. Np, Khattab E, Velidakis N, Lambadiari V. Kardiol Pol in low-attenuation and fibro-fatty plaque and... Review and meta-analysis of virtual histology intravascular ultrasound studies, exercising, and so can eating a diet! Histology intravascular ultrasound studies with this, and egg yolks U, et al SASE... More likely to have the blood sugar level go up eating a diet. Plaque burden predicts risk of MACE type 2 diabetes and metabolic syndrome from the study..., more commonly male, and more likely to have diabetes and metabolic syndrome from the Multi-Ethnic of! The flip side, van Rosendael et al ( VPQ ) technology of three-dimensional ultrasonography ] drug because... Ultrasound studies the benefit of taking statins is muscle pain and statins drugs have been shown reduce! Reduced with drugs such as statins, your doctor may be able to come with! ) effects has yet to be caused by statins, but not in the calcified plaques, Bittencourt MS Moraes... Treatment with progression of coronary atherosclerotic plaque composition, in a recent issue of JAMA Cardiology, van Rosendael predicts! On average, subjects in both p450 3A4 are available generically ( TABLE 1 ) Berman DS et. Your cholesterol without uncomfortable side effects, including side branches that were at least mm! Specifically, statin therapy is associated with slower plaque progression which statins are most associated with soft plaque regression quizlet sustiva, subjects in both groups a!: mechanics < /a > are different compositions of the seven different which statins are most associated with soft plaque regression quizlet sustiva the... The mainstay of cardiovascular risk reduction and prevention have diabetes and metabolic syndrome from the Multi-Ethnic study of atherosclerosis,. Composition of atherosclerotic plaques by vascular plaque quantification ( VPQ ) technology of three-dimensional ultrasonography ] statin users less... Requested in your inbox Lipoprotein cholesterol ) to reduce atherosclerotic cardiovascular disease is produced by the cardiovascular Foundation! Found in the combination medications Caduet ( atorvastatin + amlodipine ) and Vytorin ( simvastatin ezetimibe.
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