The effects of statin therapy on carotid plaque composition and volume: A systematic review and meta-analysis

Brinjikji, Waleed; Lehman, Vance T.; Kallmes, David F.; Rabinstein, Alejandro A.; Lanzino, Giuseppe; Murad, M. Hassan; Mulvagh, Sharon L.; Klaas, James P.; Graff‐Radford, Jonathan; DeMarco, Kevin J.; Huston, John

doi:10.1016/j.neurad.2016.12.004

Cited by 40 publications

(33 citation statements)

References 32 publications

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“…Given the association between many modifiable risk factors and IPH, it may be that improved control or even reversal of these risk factors could result in reversal of the vulnerable plaque components (i.e., IPH and lipid rich necrotic core). A number of pharmacological studies have suggested that high-intensity statin therapy can potentially reverse atherosclerotic disease and even result in removal of the lipid-rich necrotic core [27]. Based on this and the findings from our study, we hypothesize that strict management of cardiovascular risk factors may aid in stabilization of the plaque.…”

Section: Discussionsupporting

confidence: 74%

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

et al. 2020

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Introduction: Intraplaque hemorrhage (IPH) is a known predictor of symptomatic cervical carotid artery disease. However, the association between IPH and modifiable cardiovascular risk factors, patient demographics, and pertinent laboratory values has not been extensively studied. Methods: A retrospective review was performed of consecutive patients who have undergone dedicated carotid plaque imaging over a 3-year period. Patients were excluded if the MR examination did not include high-resolution carotid plaque imaging. Intraplaque hyperintense signal on carotid plaque images was presumed to represent IPH. The presence or absence of IPH was compared to various demographic and clinical variables. Multivariable regression analysis was performed in order to determine an independent association between variables and IPH. Results: Of 643 included patients, 114 patients (17.7%) had IPH in one or both carotids, 529 patients (82.3%) did not; 39.5% of patients with IPH had coronary artery disease compared to 23.1% of patients without (p = 0.0003). Patients with IPH also had higher proportions of hypertension (77.2 vs. 60.7%, p = 0.009), hyperlipid-emia (HLD; 89.5 vs. 62.4%, p < 0.0001), diabetes mellitus (29.0 vs. 18.7%, p = 0.01), and a history of tobacco smoking (63.2 vs. 52.6%, p = 0.003). Patients without IPH had, on average, higher high-density lipoprotein levels (46.1 vs. 56.7%, p = 0.003). Factors independently associated with IPH were advanced age (odds ratio [OR]: 1.1, 95% CI: [1.0-1.05], p < 0.0001), male sex (OR: 2.5, 95% CI: [1.4-4.4], p = 0.0001), presence of carotid stenosis (OR: 8.4, 95% CI: [4.6-15.3], p < 0.0001), and HLD (OR: 2.6, 95% CI: [1.3-5.2], p = 0.009). Conclusions: IPH is associated with multiple cardiovascular risk factors, in particular advanced age, male sex, presence of carotid stenosis, and HLD. Such risk factors likely play a role in the development of IPH and may provide insight into the pathophysiology of unstable carotid plaques.

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Section: Discussionsupporting

confidence: 74%

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

et al. 2020

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“…Additionally, it was reported that monoclonal antibodies against apo B-binding sites on glycosaminoglycan chains within the arterial matrix could decrease the retention of intra-arterial lipoproteins and hence could prevent the progression of atherosclerosis in apo E-deficient mice 43,44) . Statin therapy can reduce CVD events 45) through the significant reduction of lipid-rich necrotic core volume 46) , and this mechanism might have resulted in the statistically insignificant correlation between serum anti-apo B-100 Ab levels and plaque instability in the statin-treated group in the present study. Therefore, further investigation would be needed to elucidate the full range of anti-inflammatory and antiatherogenic effects of these autoantibodies.…”

Section: Discussionmentioning

confidence: 59%

Anti-Apo B-100 Autoantibody is a Marker of Unstable Coronary Plaque

Imai

Kawamura

Kochi

et al. 2021

JAT

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Aims: Cardiovascular diseases (CVD) are a global leading cause of mortality. However, few biomarkers are available to predict future coronary plaque rupture. We have recently demonstrated that low levels of anti-apolipoprotein B-100 autoantibody (anti-apo B-100 Ab) correlated with an increased CVD risk in Japanese patients with diabetes. In the present study, we examined the relationship between serum anti-apo B-100 Ab levels and coronary plaque characteristics in patients undergoing elective percutaneous coronary intervention (PCI). Methods: We conducted iMAP ® -intravascular ultrasound (IVUS) in 88 Japanese male patients undergoing elective PCI, and the five consecutive slices of IVUS images at the center of the most stenotic culprit lesion were used for identifying the plaque characteristics. The serum levels of anti-apo B-100 Ab against synthetic peptides (p45 or p210) were measured using a homemade enzyme-linked immunosorbent assay. Results: Serum IgG levels of anti-apo B-100 Ab against both native p45 and p210 (IgG N-p45 and IgG N-p210 ) and malondialdehyde (MDA)-modified p45 and p210 (IgG MDA-p45 or IgG MDA-p210 ) showed a negative correlation with plaque burden in total male patients undergoing elective PCI. Additionally, both IgG N-p45 and IgG N-p210 , but neither IgG MDA-p45 nor IgG MDA-p210 , correlated negatively with necrotic and positively with fibrotic components of iMAP ® -IVUS plaque characteristics in the patients with ＜1 month statin treatment before elective PCI (“statin-untreated” group). There was no significant correlation between anti-apo B-100 Ab and any plaque characteristics in the patients with statin treatment for 1 month or more before elective PCI (“statin-treated” group). Conclusion: Measuring serum levels of anti-apo B-100 Ab might be helpful in the evaluation of unstable coronary plaque in male CVD patients without statin treatment.

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“…Also, the relatively short time frame of 90 days set in the present study might have been too short for detecting plaque substance changes. Previous morphologic plaque studies using MRI have shown carotid plaque lipid-rich necrotic cores are substantially reduced after 12-month medical treatment, even though plaque volume is not reduced [29]. We are currently developing supplemental techniques to investigate other morphological features pivotal for identification of the vulnerable plaque.…”

Section: Discussionmentioning

confidence: 99%

Carotid plaque inflammatory activity assessed by 2-[18F]FDG-PET imaging decrease after a neurological thromboembolic event

et al. 2021

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Background Atherosclerotic plaque vulnerability is comprised by plaque composition driven by inflammatory activity and these features can be depicted with 3D ultrasound and 2-[18F]FDG-PET, respectively. The study investigated timely changes in carotid artery plaque inflammation and morphology after a thromboembolic event with PET/CT and novel ultrasound volumetric grayscale median (GSM) readings. Patients with a single hemisphere-specific neurological symptom and the presence of an ipsilateral carotid artery atherosclerotic plaque were prospectively included to both 2-[18F]FDG PET/CT and 3D ultrasound scans of the plaque immediately after their event and again three months later. On PET/CT images the maximum standardized uptake value (SUVmax) was measured and the volumetric ultrasound acquisitions were analyzed using a semiautomated software measuring GSM values. Results Baseline scans were performed by a mean of 7 days (range 2–14) after the symptom and again after 98 days (range 91–176). For the entire group (n = 14), we found a decrease in average SUVmax from baseline to follow-up of − 0.18 (95% confidence interval: − 0.34 to − 0.02, P = 0.034). GSM did not increase significantly over time (mean change: + 2.21, 95% confidence interval: − 17.02 to 21.44, P = 0.808). Conclusion A decrease in culprit lesion 2-[18F]FDG-uptake 3 months after an event indicates a decrease in inflammatory activity, suggesting that carotid plaque stabilization over time. 3D ultrasound morphological quantitative differences in GSM were not detectable after 3 months.

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The effects of statin therapy on carotid plaque composition and volume: A systematic review and meta-analysis

Cited by 40 publications

References 32 publications

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

Carotid Intraplaque Hemorrhage Is Associated with Cardiovascular Risk Factors

Anti-Apo B-100 Autoantibody is a Marker of Unstable Coronary Plaque

Carotid plaque inflammatory activity assessed by 2-[18F]FDG-PET imaging decrease after a neurological thromboembolic event

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