Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Sandesara PB, Mehta A, O'Neal WT, et al. government site. Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. Editorial commentary: The pleiotropic effect of statins on the atherosclerotic plaque and coronary heart disease. Statin intolerance. [Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography]. Clinical Pharmacology and Therapeutics.2016;99:390. Notably, statins play a role in plaque regression with reduction in lipid content. Mayo Clinic does not endorse any of the third party products and services advertised. Ann Med Surg (Lond). 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. The statin user group (22%) was older with increased classic CVD risk factor burden. All Rights Reserved. For example, low-attenuation plaque is associated with higher risk of acute coronary syndromes,5-7 whereas higher-density calcium and very dense calcium (1K) are associated with lower rates of major events for a specific plaque.3,4. Detrano R, Guerci AD, Carr JJ, et al. include protected health information. Mszar R, Nasir K, Santos RD. If its 90% dense calcium, for example, it doesnt progress on the next CT scan. All analyses were stratified by baseline statin use. Food and Drug Administration. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. NCI CPTC Antibody Characterization Program. Banach M, Serban C, Sahebkar A, et al. Cholesterol: Top foods to improve your numbers, Cholesterol-lowering supplements may be helpful. Methods: The evidence for atherosclerotic plaque regression, the important role of statins and the available imaging techniques used to investigate this condition are examined. Cox regression models were used to evaluate the associations between CAC scores with incident cardiac events controlling for traditional risk factors. So having really a low LDL cholesterol level can help stabilize any plaque buildup you have, and prevent further plaque progression. Statins prevent heart attacks in people with diabetes. Mortensen MB, Steffensen FH, Btker HE, et al. The secondary pur-pose of the present study was to assess the impact of clinical findings, laboratory findings, and intravascular ultrasound It is well known that lowering the low-density lipoprotein cholesterol (LDL-C) level is useful in both the primary and secondary prevention of cardiovascular events (16-18).Statins are the most common therapeutic agents for lipid-lowering ().The major effect of statins is the reduction of LDL-C levels through the . "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 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. Objectives: . 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. information submitted for this request. 3 Significant cardiovascular risk remains after statin therapy. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. TCTMD All rights reserved. LDL stands for Low-Density Lipoprotein and is the type of cholesterol that gets deposited in your artery walls. Careers. Mach F, et al. Coronary atherosclerotic precursors of acute coronary syndromes. ribeye steak), liver, and egg yolks. 2022 Oct 18;54(5):991-999. doi: 10.19723/j.issn.1671-167X.2022.05.028. Copyright 2023. 2023 Feb 14;12(2):477. doi: 10.3390/antiox12020477. official website and that any information you provide is encrypted Are statins safe? Coronary artery calcium and cardiovascular events in patients With familial hypercholesterolemia receiving standard lipid-lowering therapy. Budoff MJ, Muhlestein JB, Bhatt DL, Le Pa VT, May HT, Shaikh K, Shekar C, Kinninger A, Lakshmanan S, Roy SK, Tayek J, Nelson JR. Cardiovasc Res. Don't stop taking your statin medication before talking to your doctor. A case of prominent coronary plaque regression with statin therapy. 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. Chang HJ, Lin FY, Lee SE, et al. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. CAC volume and Agatston CAC score depicted associations with CVD/CHD in both groups; however, density was not associated with cardiac outcomes in statin users. Lovastatin 4. Michael ORiordan is the Associate Managing Editor for TCTMD and a Senior Journalist. 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. Which statins are the exception? Stroke. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the. Cerebrovasc Dis. Statin muscle-related adverse events. The https:// ensures that you are connecting to the Receive the the latest news, research, and presentations from major meetings right to your inbox. Uddin SMI, Mirbolouk M, Kianoush S, et al. You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque. Of these, 171,189 (13.7%) had at least 1 reported SASE since year 2000. Data on concealment of allocation, selection bias, blinding, sample size, disclosed funding source, financial ties of authors, results for primary outcomes, and author conclusions were extracted by two coders (weighted kappa 0.80 to 0.97). Nuts and your heart: Eating nuts for heart health. Targets for plaque stabilization LDL cholesterol and cardiovascular events. The statistical model was adjusted for age, sex, diabetes, hypertension, smoking status, body mass index, and the CT interval. CAC >100 warrants discussion of aspirin therapy and intensive BP goals, while CAC >300 and especially >1000 warrants intensifying lipid lowering therapy to secondary prevention levels (LDL<70), and other relevant preventive medications GLP1RAs if diabetes present, icosapent ethyl.24-30 Our group has published guidance on how a CAC-guided approach could be used for the allocation of various preventive pharmacotherapies in patients with diabetes.31. Henein MY, Vancheri S, Longo G, Vancheri F. Int J Mol Sci. If we combine this information with your protected Statin therapy contributes to plaque-stability by increasing the presence of calcification of plaque. CCTA has improved clinicians' ability to treat patients with CAD by identifying patients with at least mild coronary atherosclerotic disease; this may result in earlier implementation of treatment to reduce ASCVD risk with pharmacotherapy. Because the condition affects every artery, if . van Rosendael AR, Narula J, Lin FY, et al. J Cardiovasc Comput Tomogr. Importantly, coronary artery plaque burden predicts risk of MACE. The new study, which was published last week in JAMA Cardiology, included 857 patients with known or suspected CAD participating in the CCTA PARADIGM study. health information, we will treat all of that information as protected health Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. Unable to load your collection due to an error, Unable to load your delegates due to an error. Nakazato R, Gransar H, Berman DS, et al. Budoff MJ, Young R, Burke G, et al. The findings confirm that CAC does have prognostic value among statin users, although the association is attenuated. Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study. It is not known which factors are associated with plaque progression in patients who use statins. HMG Co-A reductase inhibitors (atorvastatin) Which drug's Mechanism of action is Upregulation of LDL receptors that remove LDL from the blood stream HMG Co-A reductase inhibitors (atorvastatin) Rationale: Statins upregulate the LDL receptors on the liver, and that removes LDL (the bad cholesterol from the bloodstream). Statin-induced muscle syndromes. The actual risk of developing muscle pain as a result of taking statins is about 5 percent or less compared with taking a pill that doesn't contain medication (placebo). A: Yes. 2019;26:e000. All rights reserved. Information for the duration and dosage of statin use was obtained from pharmacy records for all participants. 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. In patients treated with statin therapy, or other lipid-lowering agents, serially measuring CAC might reveal evidence of calcified plaque progression which does not reflect increased patient risk but rather a stabilization of the coronary plaque. Advertising revenue supports our not-for-profit mission. Epub 2016 May 10. van den Bouwhuijsen QJ, Bos D, Ikram MA, Hofman A, Krestin GP, Franco OH, van der Lugt A, Vernooij MW. Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol 190mg/dL: the Multi-Ethnic Study of Atherosclerosis. 2019 Mar-Apr;13(2):99-104. doi: 10.1016/j.jcct.2019.01.015. Active, high-dosage statin use seems to beneficially influence the composition of carotid atherosclerosis by shifting the composition from vulnerable plaque with a lipid core to more stable calcified plaque. Counterintuitively, however, coronary calcium scores continue to increase with statin therapy but probably at a slower rate.2 Furthermore, the presence of very dense calcium (>1000 Hounsfield units, or 1K) seems to be associated with lower rates of major events for a specific plaque.3,4 Therefore, delineating the effects of statin therapy on plaque composition may help guide risk estimation and management decisions for patients with CAD. Osei AD, Mirbolouk M, Berman D, et al. The association between CAC and outcomes in statin users was significantly attenuated compared to those in nonusers, however, the improvement in predictive value compared to risk factor models alone was similar in both groups. This present analysis supports findings from the above literature, i.e., suggesting a role of statin therapy in accelerating plaque transformation from noncalcified to calcified content and thus aiding plaque stabilization. Advertising on our site helps support our mission. PROSPECT II/ABSORB, EVAPORATE: Icosapent Ethyl May Slow Atherosclerosis Progression, New Chronic Coronary Syndrome Guidelines Stress Theres Nothing Stable About CAD, Effect of Icosapent Ethyl on Progression of Coronary Atherosclerosis in Patients With Elevated Triglycerides on Statin Therapy: The EVAPORATE Study, The PROSPECT ABSORB Trial: Randomized Evaluation of Vulnerable Plaque Treatment with Percutaneous Coronary Intervention, Integration of Non-Invasive and Invasive Imaging for the Detection of Vulnerable Plaques and Patients. We used logistic regression models to study the association of statin use with the presence of plaque components. Bethesda, MD 20894, Web Policies LDL can be reduced with drugs such as statins, but it can also be managed through a healthier diet and lifestyle. Osei et al. Past studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Atherosclerosis refers to the buildup of plaque in the arteries that are normally responsible for carrying blood to various vital organs of the body. This is a cross-sectional study of 192 published RCTs comparing a statin drug to another statin drug or non-statin drug. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. Cardiac computed tomography for personalized management of patients with type 2 diabetes mellitus. To provide you with the most relevant and helpful information, and understand which Clipboard, Search History, and several other advanced features are temporarily unavailable. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque, dubbed 1K plaque (> 1,000 Hounsfield units), was associated with a lower risk of ACS. On average, subjects in both groups showed a 9.2 percent increase in plaque buildup. Malik S, Zhao Y, Budoff M, et al. In patients with an initial CAC <100 who only required statin therapy, a subsequent CAC score while on statin therapy may guide stepwise introduction of additional preventive medications. 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. 2019 Nov;29(8):456-457. doi: 10.1016/j.tcm.2019.02.001. 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. Statins: Actions, side effects and administration. Results: Our cohort included 1,225,576 patients with ASCVD. Epub 2018 Jun 13. A reasonably trained CT tech should be able to identify the calcium that is residing in the coronary arteries based on his or her knowledge of the coronary anatomy as registered on CT slices. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the HUYGENS 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). Methods and Findings. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary. Puri R, Nicholls SJ, Shao M, et al. It's possible your blood sugar (blood glucose) level may increase when you take a statin, which may lead to developing type 2 diabetes. The study excluded patients with noninterpretable CCTA findings, patients without lesions at baseline as well as at follow-up, patients initiating or stopping statin after baseline CCTA, patients with unknown information regarding statin use, and those with tandem lesions at baseline that were confluent at follow-up. The .gov means its official. sharing sensitive information, make sure youre on a federal https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm. CAD severity on cardiac CTA identifies patients with most benefit of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets. Mitigation of Cardiovascular Disease and Toxicity through NRF2 Signalling. Although liver problems are rare, your doctor may order a liver enzyme test before or shortly after you begin to take a statin. Mayo Clinic is a nonprofit organization and proceeds from Web advertising help support our mission. There was a statistically significant interaction by baseline statin use, resulting in weaker associations between Agatston CAC scores and both outcomes. Damage to your liver. Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. 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. 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. The site is secure. Disclaimer. Criqui MH, Denenberg JO, Ix JH, et al. There has also been evidence that statins may help with brain function in people with dementia, for example. McEvoy JW, Martin SS, Dardari ZA, et al. Coronary artery calcification in familial hypercholesterolemia: an opportunity for risk assessment and shared decision making with the power of zero? Safety and efficacy of statin therapy. High cholesterol treatment: Does cinnamon lower cholesterol? The pain can be a mild discomfort, or it can be severe enough to make your daily activities difficult. In statins users, both the CAC Agatston score and CAC volume had prognostic utility for CHD and CVD risk, suggesting that CAC burden also predicts CHD and CVD risk in this group. Drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity mortality. Vancheri S, Longo G, Vancheri F. Int J Mol Sci ribeye steak ), liver, and further. Lipid Core within the Asymptomatic atherosclerotic carotid plaque: the Rotterdam Study all participants calcium density and lower low-attenuation fibro-fatty! 8 ):456-457. doi: 10.1016/j.jcct.2019.01.015 F. Int J Mol Sci numbers, Cholesterol-lowering supplements may be.... 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