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Statins: Friends or Enemies?
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<blockquote data-quote="Nelson Vergel" data-source="post: 114432" data-attributes="member: 3"><p>Study confirms pro-calcific effects of statins on coronary plaques in low-risk patients</p><p>July 5, 2018</p><p> </p><p>By Scott Baltic</p><p></p><p>NEW YORK (Reuters Health) - In patients without a history of coronary artery disease, statin use is associated with a slower progression of overall coronary atherosclerosis volume, a reduction of high-risk plaque features and accelerated plaque calcification, according to a new report from PARADIGM, a prospective multinational observational registry.</p><p></p><p>Statins did not, however, protect against the progression of coronary lesions to high-grade stenoses, as measured by serial coronary computed tomography angiography (CCTA), researchers report in JACC: Cardiovascular Imaging, online June 13.</p><p></p><p>Prior studies using intravascular imaging have shown that statins possess a pro-calcific effect on coronary atherosclerotic plaques, lead author Sang-Eun Lee, of Yonsei University College of Medicine in Seoul, South Korea, told Reuters Health by email.</p><p></p><p>"However, there is a knowledge gap regarding the generalizability of these results to lower-risk patients, or patients at earlier stage of the coronary atherosclerosis, who account for a much greater portion of the population, as these patients are not indicated for invasive assessment," Dr. Lee said.</p><p></p><p>The analysis covered 1,255 patients with no documented coronary artery disease before their baseline CCTA scan and who underwent at least one further CCTA scan at an interval of no less than two years.</p><p></p><p>Within this group (mean age, 60; 56.7% men), 781 took statins and 474 were statin-naive. Patients taking statins were on average older and had significantly higher prevalences of hypertension and diabetes.</p><p></p><p>Over time, statins were associated with a slowing of the increase in percent diameter stenosis, but not enough to slow the progression of non-obstructive coronary lesion to more than 50%.</p><p></p><p>Compared with statin-naive patients, those taking statins showed higher percent atheroma volume (PAV) per lesion at the initial CCTA scan. Over time, the annualized progression of coronary lesion PAV was significantly slower in statin-taking patients than in statin-naïve patients.</p><p></p><p>In addition, lesions in statin-taking patients showed higher annualized progression of calcified PAV (1.27% vs. 0.98%, P</p><p></p><p>The annualized incidence of high-risk plaque features, positive remodeling, spotty calcification and low-attenuation plaques were all significantly lower in the statin-taking group.</p><p></p><p>The study's findings, Dr. Lee said, "proved the pro-calcific effect of statins on coronary artery plaques in a low-risk population" and suggest "that increasing coronary calcification in statin-taking patients may represent stabilization of atherosclerotic lesions."</p><p></p><p>While attractive, she cautioned, this hypothesis "remains to be proven and future large-scale trials evaluating atherosclerosis treatment by targeting specific atherosclerotic phenotypes based upon plaque composition and other high-risk plaque features now seem warranted."</p><p></p><p>Although some researchers claim that statins reduce cardiac events through the calcification of plaques and that calcification equates to "stabilization" of the plaque, "whether the calcification itself is harmful or not is still under debate," Dr. Lee said. "It is still unknown whether the observed pro-calcific effect of statins would indicate a benign or malignant change" from a clinical standpoint.</p><p></p><p>Dr. Gregg W. Stone, director of Cardiovascular Research and Education at Columbia University Medical Center, in New York City, told Reuters Health by email, "This novel study adds to our understanding of the long-term plaque-specific effects of statins on coronary atherosclerotic plaque in a low-risk patient population."</p><p></p><p>Statins, he continued, "have been shown in prior invasive studies in high-risk patients to increase plaque calcification, slow lesion progression, and thicken the fibrous cap, all of which serves to reduce plaque vulnerability. The results of the present study are consistent with those findings."</p><p></p><p>"These data collectively suggest that in concert with their anti-inflammatory effects and other pleiotropic actions, statins reduce myocardial infarction and cardiovascular death by reducing plaque progression and conversion to a high-risk plaque phenotype more prone to thrombose."</p><p></p><p>The study did not have commercial funding. Several authors disclosed ties to statin manufacturers.</p></blockquote><p></p>
[QUOTE="Nelson Vergel, post: 114432, member: 3"] Study confirms pro-calcific effects of statins on coronary plaques in low-risk patients July 5, 2018 By Scott Baltic NEW YORK (Reuters Health) - In patients without a history of coronary artery disease, statin use is associated with a slower progression of overall coronary atherosclerosis volume, a reduction of high-risk plaque features and accelerated plaque calcification, according to a new report from PARADIGM, a prospective multinational observational registry. Statins did not, however, protect against the progression of coronary lesions to high-grade stenoses, as measured by serial coronary computed tomography angiography (CCTA), researchers report in JACC: Cardiovascular Imaging, online June 13. Prior studies using intravascular imaging have shown that statins possess a pro-calcific effect on coronary atherosclerotic plaques, lead author Sang-Eun Lee, of Yonsei University College of Medicine in Seoul, South Korea, told Reuters Health by email. "However, there is a knowledge gap regarding the generalizability of these results to lower-risk patients, or patients at earlier stage of the coronary atherosclerosis, who account for a much greater portion of the population, as these patients are not indicated for invasive assessment," Dr. Lee said. The analysis covered 1,255 patients with no documented coronary artery disease before their baseline CCTA scan and who underwent at least one further CCTA scan at an interval of no less than two years. Within this group (mean age, 60; 56.7% men), 781 took statins and 474 were statin-naive. Patients taking statins were on average older and had significantly higher prevalences of hypertension and diabetes. Over time, statins were associated with a slowing of the increase in percent diameter stenosis, but not enough to slow the progression of non-obstructive coronary lesion to more than 50%. Compared with statin-naive patients, those taking statins showed higher percent atheroma volume (PAV) per lesion at the initial CCTA scan. Over time, the annualized progression of coronary lesion PAV was significantly slower in statin-taking patients than in statin-naïve patients. In addition, lesions in statin-taking patients showed higher annualized progression of calcified PAV (1.27% vs. 0.98%, P The annualized incidence of high-risk plaque features, positive remodeling, spotty calcification and low-attenuation plaques were all significantly lower in the statin-taking group. The study's findings, Dr. Lee said, "proved the pro-calcific effect of statins on coronary artery plaques in a low-risk population" and suggest "that increasing coronary calcification in statin-taking patients may represent stabilization of atherosclerotic lesions." While attractive, she cautioned, this hypothesis "remains to be proven and future large-scale trials evaluating atherosclerosis treatment by targeting specific atherosclerotic phenotypes based upon plaque composition and other high-risk plaque features now seem warranted." Although some researchers claim that statins reduce cardiac events through the calcification of plaques and that calcification equates to "stabilization" of the plaque, "whether the calcification itself is harmful or not is still under debate," Dr. Lee said. "It is still unknown whether the observed pro-calcific effect of statins would indicate a benign or malignant change" from a clinical standpoint. Dr. Gregg W. Stone, director of Cardiovascular Research and Education at Columbia University Medical Center, in New York City, told Reuters Health by email, "This novel study adds to our understanding of the long-term plaque-specific effects of statins on coronary atherosclerotic plaque in a low-risk patient population." Statins, he continued, "have been shown in prior invasive studies in high-risk patients to increase plaque calcification, slow lesion progression, and thicken the fibrous cap, all of which serves to reduce plaque vulnerability. The results of the present study are consistent with those findings." "These data collectively suggest that in concert with their anti-inflammatory effects and other pleiotropic actions, statins reduce myocardial infarction and cardiovascular death by reducing plaque progression and conversion to a high-risk plaque phenotype more prone to thrombose." The study did not have commercial funding. Several authors disclosed ties to statin manufacturers. [/QUOTE]
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Statins: Friends or Enemies?
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