Effects of long-term statin-treatment on coronary atherosclerosis in patients with inflammatory joint diseases

Abstract

BackgroundThe effect of statins over time on coronary atherosclerosis in patients with inflammatory joint diseases (IJD) is unknown. Our aim was to evaluate the change in coronary plaque morphology and volume in long-term statin-treated patients with IJD.MethodsSixty-eight patients with IJD and carotid artery plaque(s) underwent coronary computed tomography angiography before and after a mean of 4.7 (range 4.0–6.0) years of statin treatment. The treatment target for low density lipoprotein cholesterol (LDL-c) was ≤1.8 mmol/L. Changes in plaque volume (calcified, mixed/soft and total) and coronary artery calcification (CAC) from baseline to follow-up were assessed using the 17-segment American Heart Association-model.ResultsMedian (IQR) increase in CAC after statin treatment was 38 (5–236) Agatston units (p<0.001). Calcified and total plaque volume increased with 5.6 (0.0–49.1) and 2.9 (0.0–23.5) mm3, respectively (p<0.001 for both). The median (IQR) change in soft/mixed plaque volume was -10 (-7.1–0.0), p = <0.001. Patients who had obtained the LDL-c treatment target at follow-up, experienced reduced progression of both CAC and total plaque volume compared to patients with LDL-c >1.8mmol/L (21 [2–143] vs. 69 [16–423], p = 0.006 and 0.65 [-1.0–13.9] vs. 13.0 [0.0–60.8] mm3, p = 0.019, respectively).ConclusionsA progression of total atherosclerotic plaque volume in statin-treated patients with IJD was observed. However, soft/mixed plaque volume was reduced, suggesting an alteration in plaque composition. Patients with recommended LDL-c levels at follow-up had reduced atherosclerotic progression compared to patients with LDL-c levels above the treatment target, suggesting a beneficial effect of treatment to guideline-recommended lipid targets in IJD patients.

The impact of lipid-lowering medications on coronary artery plaque characteristics

“…Hinting at a pleiotropic effect, in a meta-analysis of 1623 participants, high-intensity statin therapy correlated with significant plaque regression irrespective of reaching an LDL-C target ≤70 mg/dL [50] . Other studies support regression being more likely at LDL-C ≤ 70 mg/dL or even lower [ 35 , 51 , 52 ].…”

“…First, statin treatment tends to correlate with an increase in plaque calcification, likely allowing for less vulnerability [34] . In a study involving long-term statin users (mean 4.7 years of therapy) assessed by CCTA and CAC, despite the progression of plaque volume, there was a reduction in the number of soft unstable plaques and an increase in calcified plaques [35] . In another study of patients with type 2 diabetes mellitus and advanced atherosclerosis, the progression of CAC was found to be significantly higher in patients who reported higher adherence to statins (95%) than those who reported lower adherence (14%) [36] .…”