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Observational Study
. 2018 Oct;11(10):1475-1484.
doi: 10.1016/j.jcmg.2018.04.015. Epub 2018 Jun 13.

Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study

Sang-Eun Lee  1 , Hyuk-Jae Chang  2 , Ji Min Sung  1 , Hyung-Bok Park  3 , Ran Heo  4 , Asim Rizvi  5 , Fay Y Lin  5 , Amit Kumar  5 , Martin Hadamitzky  6 , Yong Jin Kim  7 , Edoardo Conte  8 , Daniele Andreini  8 , Gianluca Pontone  8 , Matthew J Budoff  9 , Ilan Gottlieb  10 , Byoung Kwon Lee  11 , Eun Ju Chun  12 , Filippo Cademartiri  13 , Erica Maffei  14 , Hugo Marques  15 , Jonathon A Leipsic  16 , Sanghoon Shin  17 , Jung Hyun Choi  18 , Kavitha Chinnaiyan  19 , Gilbert Raff  19 , Renu Virmani  20 , Habib Samady  21 , Peter H Stone  22 , Daniel S Berman  23 , Jagat Narula  24 , Leslee J Shaw  21 , Jeroen J Bax  25 , James K Min  5
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Free article
Observational Study

Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study

Sang-Eun Lee et al. JACC Cardiovasc Imaging. 2018 Oct.
Free article

Abstract

Objectives: This study sought to describe the impact of statins on individual coronary atherosclerotic plaques.

Background: Although statins reduce the risk of major adverse cardiovascular events, their long-term effects on coronary atherosclerosis remain unclear.

Methods: We performed a prospective, multinational study consisting of a registry of consecutive patients without history of coronary artery disease who underwent serial coronary computed tomography angiography at an interscan interval of ≥2 years. Atherosclerotic plaques were quantitatively analyzed for percent diameter stenosis (%DS), percent atheroma volume (PAV), plaque composition, and presence of high-risk plaque (HRP), defined by the presence of ≥2 features of low-attenuation plaque, positive arterial remodeling, or spotty calcifications.

Results: Among 1,255 patients (60 ± 9 years of age; 57% men), 1,079 coronary artery lesions were evaluated in statin-naive patients (n = 474), and 2,496 coronary artery lesions were evaluated in statin-taking patients (n = 781). Compared with lesions in statin-naive patients, those in statin-taking patients displayed a slower rate of overall PAV progression (1.76 ± 2.40% per year vs. 2.04 ± 2.37% per year, respectively; p = 0.002) but more rapid progression of calcified PAV (1.27 ± 1.54% per year vs. 0.98 ± 1.27% per year, respectively; p < 0.001). Progression of noncalcified PAV and annual incidence of new HRP features were lower in lesions in statin-taking patients (0.49 ± 2.39% per year vs. 1.06 ± 2.42% per year and 0.9% per year vs. 1.6% per year, respectively; all p < 0.001). The rates of progression to >50% DS were not different (1.0% vs. 1.4%, respectively; p > 0.05). Statins were associated with a 21% reduction in annualized total PAV progression above the median and 35% reduction in HRP development.

Conclusions: Statins were associated with slower progression of overall coronary atherosclerosis volume, with increased plaque calcification and reduction of high-risk plaque features. Statins did not affect the progression of percentage of stenosis severity of coronary artery lesions but induced phenotypic plaque transformation. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411).

Keywords: coronary artery atherosclerosis; coronary artery disease; coronary computed tomography angiography; statins.

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