Effect of statin therapy on the progression of coronary atherosclerosis

Abstract

BackgroundAn increasing number of authors employing intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) have investigated the effect of statin use on plaque volume (PV) and plaque composition. However, inconsistent results have been reported. Therefore, we conducted a meta-analysis to determine the appropriate regimen of statins to effectively stabilize vulnerable coronary plaques.MethodsOnline electronic databases were carefully searched for all relevant studies. We compared mean values of PV and plaque composition between baseline and follow-up in patients receiving statin therapy. We pooled treatment effects and calculated mean differences (MD) with the 95% confidence interval (CI) using a random-effects model. By stratified analyses, we explored the influence of clinical presentation, dose and duration of statin treatment, and low-density lipoprotein-cholesterol (LDL-C) levels on the effects of statins.ResultsSeventeen studies involving 2,171 patients were analyzed. Statin therapy significantly decreased PV (−5.3 mm3; 95% CI: –3.3 mm3 to −7.2 mm3; P < 0.001), without heterogeneity. When considering the dose and duration of statins used, only subgroups employing a high dose and long duration demonstrated a significant reduction in PV (p < 0.001). A significant decrease in PV was noted if achieved LDL-C levels were <100 mg/dL (p < 0.001). Statin treatment could induce a twofold decrease in PV in patients with acute coronary syndrome (ACS) compared with that observed in patients with stable angina pectoris (SAP). A regressive trend was seen for necrotic core volume (MD: –2.1 mm3; 95% CI: –4.7 mm3 to 0.5 mm3, P = 0.11). However, statin use did not induce a significant change for fibrotic, fibro-fatty, or dense calcium compositions.ConclusionsOur meta-analysis demonstrated that statin therapy (especially that involving a high dose and long duration and achieving <100 mg/dL LDL-C levels) can significantly decrease PV in patients with SAP or ACS. These data suggested that statins can be used to reduce the atheroma burden for secondary prevention by appropriately selecting the statin regimen. No significant change in plaque composition was seen after statin therapy.

Antiatherosclerotic Effects of Long-Term Maximally Intensive Statin Therapy After Acute Coronary Syndrome

“…Findings of the present analysis are consistent with those of a recent meta-analysis evaluating the effect of statins on the IVUS-derived progression of coronary atherosclerosis, which uncovered a 2-fold greater decrease in coronary atheroma volume in patients with ACS when compared with those with stable coronary disease after statins. 25 An explanation of these findings may relate to underlying differences in coronary atheroma composition in patients with ACS when compared with stable patients. Pathological and imaging studies have demonstrated the coronary tree of patients with ACS to contain greater amounts of lipid-laden plaque and inflammatory infiltrate, occurring diffusely, when compared with non-ACS patients.…”

Effects of intensive lipid-lowering therapy on coronary plaques composition in patients with acute myocardial infarction: Assessment with serial coronary CT angiography

“…Patients were only treated with intensive LLT for 12 months, and it is possible that the shorter follow-up period could have been the reason for the absent regression in total plaque volume. Importantly, a recent metaanalysis of IVUS studies showed that regression in total plaque volume is correlated with LDL levels and the duration of statin treatment [29]. Another explanation could be a potential lower sensitivity of CTA to detect changes in total plaque volume compared to IVUS.…”

“…Inter-observer variability before alteration in plaque volume is seen [29]. Furthermore, emerging evidence suggests that statins possess a wide range of beneficial effects on the cardiovascular system, including endothelial stabilisation, attenuation of oxidative stress, and modification of the inflammatory response [9].…”

Effects of 4 Statins on Regression of Coronary Plaque in Acute Coronary Syndrome

“…5,22-25 Previous studies also showed that coronary plaque regression induced by statin therapy appeared to be more predominant in ACS patients than in non-ACS patients. [26][27][28] This may be related to the underlying differences in coronary plaque composition in patients with ACS compared with those with stable angina pectoris. In pathology and imaging studies, ACS patients have a larger percentage of lipid-laden plaque with inflammatory cells, 29 compared with a higher percentage of fibrocalcific plaque in patients with chronic stable lesions.…”