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 Effects of Statins on Coronary Atherosclerosis  Effects of Statins on Coronary Atherosclerosis

Effects of Statins on Coronary Atherosclerosis - PowerPoint Presentation

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Effects of Statins on Coronary Atherosclerosis - PPT Presentation

Result from the P rogression of A the R osclerotic Pl A que D eterm I ned by Computed Tomo G raphic Angiography I M aging PARADIGM study SangEun Lee HyukJae Chang ID: 774858

001 statin plaque patients 001 statin plaque patients baseline hospital ccta coronary lesions south korea statins university high year

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Slide1

Effects of Statinson Coronary AtherosclerosisResult from the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) study

Sang-Eun Lee,

Hyuk-Jae Chang

, Ji Min Sung, Hyung-Bok Park, Ran

Heo

,

Asim

Rizvi, Martin

Hadamitzky

, Yong-

Jin

Kim,

Edoardo

Conte, Daniele

Andreini

, Gianluca

Pontone

, Matthew J.

Budoff

,

Ilan

Gottlieb,

Byoung

Kwon Lee, Eun Ju Chun, Filippo

Cademartiri

, Erica Maffei, Hugo Marques, Jonathon A. Leipsic,

Sanghoon

Shin, Jung Hyun Choi,

Namsik

Chung,

Renu

Virmani

, Habib

Samady

, Peter H. Stone, Daniel S. Berman,

Jagat

Narula

,

Leslee

J. Shaw, Jeroen J.

Bax

, James K.

Min

Yonsei University College of Medicine, Seoul, South Korea;

Myongji

Hospital,

Goyang

, South Korea;

Asan

Medical Center, Seoul, South Korea; York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA; German Heart Center, Munich, Germany; Seoul National University Hospital, South Korea; IRCCS, Milan, Italy; Harbor UCLA Medical Center, Los Angeles, CA, USA; Casa de

Saude

São Jose, Rio de Janeiro, Brazil; Gangnam Severance Hospital, Seoul, South Korea; Seoul National University

Bundang

Hospital, South Korea; Montréal Heart Institute/

Université

de Montréal, Montréal, Quebec, Canada; Hospital da Luz, Lisbon, Portugal; University of British Columbia, Vancouver, Canada; National Health Insurance Service

Ilsan

Hospital, South Korea; Busan University Hospital, Busan, South Korea;

CVPath

Institute, Gaithersburg, Maryland; Emory University School of Medicine, Atlanta, GA, USA; Brigham and Women's Hospital, Boston, MA, USA; Cedars-Sinai Medical Center, Los Angeles, CA, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Leiden University Medical Center, Leiden, The Netherlands

Slide2

Statins have been effective at reducing risk of major adverse cardiac events.

Source:

Sacks et al. NEJM 1996;335:1001-9.

In previous studies, statin decreased the lipid burden and increased the fibrous components.

But limited to small number of patients, short durations of follow-up, and qualitative metrics.

Source:

Hattori et al. J Am Coll

Cardiol Img 2012;5:169 –77

Background

Slide3

Background

Uncertainty exists as to the precise effects of statins on changes in coronary atherosclerotic plaque characteristics.

Coronary CT angiography (CCTA) is a non-invasive test with high performance that enables both quantitative analysis of plaque burden and plaque characterization.

Assessing impact of statins on clinical outcomes

Assessing impact of statins on atherosclerosis

Target patient group of previous studies evaluating impact of statins

Severity of coronary heart disease

Slide4

To determine the long-term effects of statins on coronary atherosclerosis.

Purpose

Slide5

Study Design & Population

Dynamic multinational observational prospective registry Study Criteria

Inclusion criteria

Consecutive patients with suspected or known coronary artery disease undergoing serial CCTAs at an inter-scan interval of

2 years

Exclusion criteria

Prior coronary artery disease before baseline CCTA (CCTA-1)

No information on statin at both baseline (CCTA-1) and follow-up CCTA (CCTA-2)

Patients who discontinued statin use after the CCTA-1

Patients with non-interpretable CCTA

Slide6

CONSORT diagram

13 sites from 7 countries enrolled between 2003 and 2015

Slide7

CCTA Analysis

Core laboratoryIntegrative Cardiac Imaging Research Center, Severance Hospital, Seoul, KoreaLevel III experienced readersQAngioCT Research Edition v2·1·9·1 (Medis Medical Imaging Systems, the Netherlands)

Measured parameters

Plaque volume (PV, mm

3

): sub-classified by pre-defined Hounsfield unit cutoff values

% diameter stenosis (%DS)

High-risk plaque (HRP) features: positive remodeling, low-attenuation plaque, spotty calcification

* Segment matching between baseline & follow-up CT – using branch point

Slide8

Primary EndpointThe annualized per-lesion change in plaque volumes between CTA-1 and CTA-2 for statin-naïve versus statin-taking patientsSecondary EndpointAnnualized change in PV by compositionsDevelopment of high-risk plaque and its constituent featuresDevelopment of obstructive coronary lesions (≥50% diameter stenosis)

Study Endpoints

Slide9

Patient Characteristics

 

Total

(n=1,255)

Statin-naïve patients

(n=474)

Statin-taking patients

(n=781)

P

P

Age,

years

60.4±9.2

59.2±9.6

61.1±8.8

0∙0002

<0.001

Male sex

712 (57%)

260 (55%)

452 (58%)

0∙2948

0.295

CTA interval, years

3.8±1.6

3.7±1.6

3.9±1.6

0∙0155

0.016

Hypertension

654 (52%)

217 (46%)

437 (56%)

0∙0004

<0.001

Diabetes mellitus

261 (21%)

70 (15%)

191 (25%)

<∙0001

<.001

Family history of CAD

337 (27%)

117 (25%)

220 (28%)

0∙1768

0.177

Smoking history

467 (37%)

178 (38%)

289 (37%)

0∙8280

0.828

Cardiac

symptom

1,062 (97%)

400 (97%)

662 (97%)

0∙5396

0.50

Baseline Lipid Profile

Total

cholesterol,

mg/

dL

190.4±40.2

186.6±34.5

192.7±43.1

0.008

LDL, mg/

dL

116.0±34.9

114.1±28.7

117.1±38.2

0.123

HDL, mg/

dL

50.9±14.1

51.3±14.2

50.7±14.0

0.490

Slide10

CTA Findings According to Statin Therapy

 

Lesions in statin-naïve patients

(n=1,079)

P

value between baseline

vs. FU

Lesions in statin-taking patients

(n=2,496)

P

value between baseline

vs. FU

P

value between groups

Baseline

FU

Baseline

FU

Baseline

FU

Stenosis severity

%DS ≥ 50%

12 (1

%

)

23 (2

%

)

0.028

40 (2

%

)

76 (3

%

)

<.001

0.261

0.127

Stenosis severity, %

11.6±12.7

18.2±12.4

<.001

14.4±13.8

20.1±13.2

<.001

<.001

<.001

Annual change in %DS, %/year

1.9±3.8

1.5±3.8

0.009

High-risk plaque characteristics

High-risk plaque

108 (10%)

170 (16%)

<.001

342 (14%)

428 (17%)

<.001

0.002

0.306

Positive remodeling

514 (48

%

)

799 (74

%

)

<.001

1,398 (56

%

)

1,901 (76

%

)

<.001

<.000

0.178

Low-attenuation plaque

91 (8

%

)

111 (10

%

)

0.027

212 (8

%

)

233 (9

%

)

0.096

0.953

0.375

Spotty calcification

73 (7

%

)

113 (10

%

)

<.001

254 (10

%

)

332 (13

%

)

<.001

0.001

0.019

Slide11

Plaque Volume at Baseline

 

Lesions in statin-naïve patients

(n=1,079)

Lesions in statin-taking patients

(n=2,496)

P

value

Total PV, mm

3

27.32±57.82

37.24±72.32

<.001

Calcified PV, mm

3

7.68±22.49

14.00±39.08

<.001

Fibrous

PV

, mm

3

12.69±28.21

16.20±31.30

0.001

Fibrous fatty

PV

, mm

3

6.20±17.39

6.28±16.39

0.898

Necrotic core

PV

, mm

3

0.75±3.39

0.77±3.39

0.950

Slide12

Annualized Change in Plaque Volume

 

Lesions in statin-naïve patients

(n=1,079)

Lesions in statin-taking patients

(n=2,496)

P

value

Total PV, mm

3

/year

5.35±10.06

4.61±9.67

0.039

Calcified PV, mm

3

/year

2.35±4.72

3.10±6.55

<0.001

Fibrous PV, mm

3

/year

2.24±5.80

1.42±5.79

<0.001

Fibrous fatty PV, mm

3

/year

0.72±5.50

0.10±4.01

<0.001

Necrotic core PV, mm

3

/year

0.04±1.14

-0.0003±0.88

0.271

Slide13

Effects of Statin on Atherosclerosis

Slide14

Conclusions

Statins are associated with

Slower progression of overall coronary atherosclerosis volume

Increased plaque calcification

Reduction of high-risk plaques

Statins are not associated with lesions progressing to high-grade stenoses.

Slide15

Thank You