Influence of Lipid-Lowering Therapy on the Progression of Coronary Artery Calcification

Abstract

Background-Coronary calcification measured by fast computed tomography techniques is a surrogate marker of coronary atherosclerotic plaque burden. In a cohort study, we prospectively investigated whether lipid-lowering therapy with a cholesterol synthesis enzyme inhibitor reduces the progression of coronary calcification. Methods and Results-In 66 patients with coronary calcifications in electron beam tomography (EBT), LDL cholesterol Ͼ130 mg/dL, and no lipid-lowering treatment, the EBT scan was repeated after a mean interval of 14 months and treatment with cerivastatin was initiated (0.3 mg/d). After 12 months of treatment, a third EBT scan was performed. Coronary calcifications were quantified using a volumetric score. Cerivastatin therapy lowered the mean LDL cholesterol level from 164Ϯ30 to 107Ϯ21 mg/dL. The median calcified volume was 155 mm 3 (range, 15 to 1849) at baseline, 201 mm 3 (19 to 2486) after 14 months without treatment, and 203 mm 3 (15 to 2569) after 12 months of cerivastatin treatment. The median annualized absolute increase in coronary calcium was 25 mm 3 during the untreated versus 11 mm 3 during the treatment period (Pϭ0.01). The median annual relative increase in coronary calcium was 25% during the untreated versus 8.8% during the treatment period (PϽ0.0001). In 32 patients with an LDL cholesterol level Ͻ100 mg/dL under treatment, the median relative change was 27% during the untreated versus Ϫ3.4% during the treatment period (Pϭ0.0001). Conclusions-Treatment with the cholesterol synthesis enzyme inhibitor cerivastatin significantly reduces coronary calcium progression in patients with LDL cholesterol Ͼ130 mg/dL.

Increased Lipogenesis and Stearate Accelerate Vascular Calcification in Calcifying Vascular Cells

“…In addition to phosphate, inflammatory cytokines, and oxidative stress, several in vitro and clinical studies have shown lipids to play a crucial role in the pathogenesis of vascular calcification. Lipid-lowering drugs including statins are in fact effective in reducing vascular calcification in several clinical trials (7)(8)(9). In vascular calcification, n-3 unsaturated fatty acids play a protective role through a p38-MAPK (mitogen-activated protein kinase)-dependent mechanism, whereas oxidized lipids such as oxysterols and oxidized phospholipids elicit procalcific effects in vascular cells.…”

Progression of Coronary Artery Calcium and Occurrence of Myocardial Infarction in Patients With and Without Diabetes Mellitus

“…4 -7 During the past several years, coronary artery calcium (CAC) measured by electron beam tomography (EBT) has evolved into a useful tool for risk prediction, 8 -12 and monitoring of CAC progression over time has been proposed as a tool to follow the evolution of the atherosclerotic plaque burden. 13,14 To further support the utility of this tool, initial evidence indicates that progression of CAC is linked to an unfavorable prognosis. 15,16 In this retrospective study, we reviewed the data collected in 1310 individuals submitted to sequential EBT scanning, 157 of whom were affected by diabetes, to assess the difference in plaque burden growth in patients with and without diabetes mellitus.…”

Interseção cardiorrenal: confluência para o futuro

“…In a study of 66 subjects who were followed during a periods without statin treatment and then during treatment with cerivastatin 0.3 mg p.o. qd, the overall median annualized relative change was significantly higher in the untreated interval compared with the treated interval (25% vs 8.8%, P< 0.0001) 51 . The annualized relative change of the CAC score in 32 patients who achieved an LDL-C level of < 100 mg/dL decreased from 27% to -3.4% (P< 0.0001).…”