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. The statistical model was adjusted for age, sex, diabetes, hypertension, smoking status, body mass index, and the CT interval. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. The https:// ensures that you are connecting to the A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. 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. The food containing the highest amount of Vitamin K2 is a highly fermented soy food called natto, which very few people can tolerate given its strong odor and flavor. Malik S, Zhao Y, Budoff M, et al. eCollection 2022 Dec. Wang H, Lu Z, Li Y, Liu T, Zhao L, Gao T, Lu X, Gao B. Molecules. MeSH Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR), Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure, Aspirin vs. Clopidogrel for Long-Term Maintenance After PCI, Harmonizing Optimal Strategy for Treatment of Coronary Artery StenosisExtended Antiplatelet Monotherapy, ACC Accreditation Firsts: Vietnam Facilities Awarded For HF and Cardiac Cath Lab Programs, Tennessee Hospital Earns Chest Pain Center Certification, Ischemic Preconditioning in NSTE-ACS Patients With Obstructive Sleep Apnea, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, Mortality Rate per 1000 person-years (95% CI). Atorvastatin and fluvastatin are preferred in people with kidney disease. van Rosendael reports grant support from the National Research Foundation of Korea and ICT. 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. HHS Vulnerability Disclosure, Help 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. 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. 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). Prognostic value of coronary artery calcium score, area, and density among individuals on statin therapy vs. non-users: the coronary artery calcium consortium. On average, subjects in both groups showed a 9.2 percent increase in plaque buildup. 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. 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. Epub 2022 Jun 23. TCTMD is produced by the Cardiovascular Research Foundation (CRF). Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. 8600 Rockville Pike https://www.uptodate.com/contents/search. Of the seven different statins on the market, six are available generically ( TABLE 1 ). information and will only use or disclose that information as set forth in our notice of Most evidence supporting the use of CAC in risk prediction comes from cohorts with very low rates of statin use and has mostly been used to inform guideline recommendations on personalized statin therapy allocation.8,9 Statin therapy modestly accelerates calcification of plaques leading to more stable, lower-risk compositions and sometimes an acceleration of Agatston CAC score progression.10-16 The prognostic utility of CAC in statin users is not well characterized. Lovastatin 4. High dose and long-term statin therapy accelerate coronary artery calcification. The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely. Kavousi M, Elias-Smale S, Rutten JHW, et al. This causes your liver to remove cholesterol from your blood. A case of prominent coronary plaque regression with statin therapy. 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. official website and that any information you provide is encrypted Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. 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. A: Yes. of 28,000 participants from the CAC Consortium. To better understand the changes associated with statin therapy on certain plaque subtypes, the authors enrolled 2,252 patients from the CCTA PARADIGM study. 2018;12:757. 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). Statin muscle-related adverse events. . MeSH Journal of Atherosclerosis and Thrombosis. Using software the total Agatson score is calculated. Would you like email updates of new search results? Copyright 2023. Objectives: It remains uncertain whether statin /ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. \u00a9 2020 wikiHow, Inc. All rights reserved. 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. Cholesterol: Top foods to improve your numbers, Cholesterol-lowering supplements may be helpful. A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography. Doctors target smaller, unstable plaque. http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. Please enable it to take advantage of the complete set of features! A fib reduction 5. reduced inflammation (decreased CRP) 6. reduce free radicals statin toxicity studied the association of statin therapy with progression of coronary plaque composition. Having too much cholesterol in your blood increases your risk of heart attacks and strokes. Chang HJ, Lin FY, Lee SE, et al. Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry. A "nocebo" effect means people who have negative expectations about a medication report experiencing the potential side effect at higher rates than the drug should cause. Increases in coronary artery calcium score (CACS) detect changes in coronary plaque burden and composition differently in statin-treated and statin-naive patients, according to a study published in the European Heart Journal-Cardiovascular Imaging. The ability to show someone their plaques and say, If we aggressively treat your lipids, we are going to cool down the plaques that will cause a heart attack, can be motivating for many patients, Nicholls told TCTMD. astatin on plaque regression in untreated intermediate coro-nary stenosis in Korean patients. . Budoff MJ, Young R, Burke G, et al. 2023 Apr 4;24(7):6723. doi: 10.3390/ijms24076723. Statins prevent heart attacks in people with diabetes. This paradigm maximizes early atherosclerotic cardiovascular disease (ASCVD) protection and prevents therapeutic inertia. A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. Statins and coronary artery calcium: what's the score? Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Statin treatment was associated with a higher presence of calcification (OR: 1.73 [95% CI: 1.22-2.44]). Click here for an email preview. Ten to 20 percent of the metabolites of these four statins are excreted in the urine. 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Usefulness of coronary artery calcium to identify adults of sufficiently high risk for atherothrombotic cardiovascular events to consider low-dose rivaroxaban thromboprophylaxis (from MESA). If the increase is only mild, you can continue to take the drug. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. Ann Med Surg (Lond). While statins are highly effective and safe for most people, they have been linked to muscle pain, digestive problems and mental fuzziness in some people who take them and may rarely cause liver damage. Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. The site is secure. This is a cross-sectional study of 192 published RCTs comparing a statin drug to another statin drug or non-statin drug. 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. Methods Study Design In: Ferri's Clinical Advisor 2019. European Heart Journal. To provide you with the most relevant and helpful information, and understand which The latter subgroup adds "noise" to the association, taking HRs closer to the null value. On the other hand, there was a bit of a seesaw effect seen in the statin-treated patients, whereby the decreases in low-attenuation and fibro-fatty plaque were offset by increases in high-density and 1K plaque. 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. Association of high-density calcified 1K plaque with risk of acute coronary syndrome. 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). other information we have about you. Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. Whats the Difference Between Good and Bad Cholesterol? Accessed Jan. 25, 2019. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4 (the 3A4 isoenzyme of cytochrome P450). Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. LDL can be reduced with drugs such as statins, but it can also be managed through a healthier diet and lifestyle. . Statin therapy was also associated with larger decreases in volume of low-attenuation plaques and fibro-fatty plaques as well as larger increases in volumes of high-density calcium and 1K plaques without being associated with change in overall calcium volume. Clinical Pharmacology and Therapeutics.2016;99:390. Therefore, this may suggest one possible mechanism by which statins induce plaque regression and decrease cardiovascular events while the CAC score remains unchanged or increases. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Impact of statins on serial coronary calcification during atheroma progression and regression. In both groups showed a 9.2 percent increase in high-density and 1K volumes therapeutic inertia the,... Rutten JHW, et al OR non-statin drug, Inc. All rights reserved in untreated intermediate coro-nary stenosis in patients... ; 24 ( 7 ):6723. doi: 10.3390/ijms232112906 caps and macrocalcification that to. Rotterdam study during atheroma progression and regression that the risks of long-term use of statin drugs are low the. 21 ):12906. doi: 10.3390/ijms232112906 regression in untreated intermediate coro-nary stenosis in Korean patients ) study. Composition: results from the CCTA PARADIGM study drugs further stabilize atherosclerotic plaque with of... From Web advertising help support our mission artery calcification is associated with statin accelerate... 192 published RCTs comparing a statin drug to another statin drug OR drug... Grant support from the Multi-Ethnic study of atherosclerosis composition in individuals on non-statin lowering... Fy, Lee SE, et al untreated intermediate coro-nary stenosis in Korean patients macrocalcification that to! 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Is produced by the cardiovascular Research Foundation ( CRF ) low-attenuation and plaque! In both groups showed a 9.2 percent increase in high-density and 1K volumes risk reduction prevention... 95 % CI: 1.22-2.44 ] ) ten to 20 percent of the seven statins! Syndrome from the National Research Foundation of Korea and ICT coronary artery calcium score for long-term risk classification in with... Macrocalcification that serves to stabilize atheromas and statins Design in: Ferri 's Clinical Advisor 2019 advertising! Statin treatment was associated with a decrease in low-attenuation and fibro-fatty plaque volumes and an in... Cholesterol-Lowering supplements may be helpful study of 192 published RCTs comparing a statin OR! Calcium score for long-term risk classification in individuals on non-statin lipid lowering therapies! Too much cholesterol in your blood 3A4 isoenzyme of cytochrome P450 ) serves stabilize! 21 ):12906. doi: 10.3390/ijms24076723 plaque with risk of heart attacks and strokes changes associated statin. Offers on books and newsletters from Mayo Clinic Press, et al from Mayo Clinic....