Coronary artery calcium to guide a personalized risk-based approach to initiation and intensification of antihypertensive therapy. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrao R.. Quantification of coronary artery calcium using ultrafast computed tomography. Mujaj B, Bos D, Muka T, Lugt AV, Ikram MA, Vernooij MW, Stricker BH, Franco OH. 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). Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Statin intolerance. Puri R, Nicholls SJ, Shao M, et al. 2018;12:757. Rarely, if the increase is severe, you may need to try a different statin. For patients undergoing CAC screening, the new data can help refine how best to assess patient risk. Before Disclaimer. While CAC scores are a strong predictor of future events, the score incorporates both calcified and noncalcified plaques. Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Keywords: Dyslipidemias, Calcium, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Coronary Vessels, Hyperlipoproteinemia Type II, Secondary Prevention, Research Design, Reference Values, Prognosis, Retrospective Studies, Follow-Up Studies, Area Under Curve, Coronary Disease, Risk Factors, Risk Assessment, Diabetes Mellitus, Diabetes Mellitus, Risk Reduction Behavior, Chest Pain, Atherosclerosis, Cardiology, Reference Standards, Acceleration, Aspirin, Lipids, Resource Allocation. 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). Whether these benefits are purely through lipid lowering or pl Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. High dose and long-term statin therapy accelerate coronary artery calcification. Unauthorized use of these marks is strictly prohibited. Inclusion of CAC volume improved CVD/CHD prediction significantly while calcium density provided minimal additional predictive value in statin users. 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. Accessed Jan. 24, 2019. This site needs JavaScript to work properly. Osei AD, Mirbolouk M, Berman D, et al. In patients not on a statin, low-attenuation and fibro-fatty plaque volumes increased over time. German CA, Shapiro MD. Damage to your kidneys. Of the seven different statins on the market, six are available generically ( TABLE 1 ). of 28,000 participants from the CAC Consortium. Statin therapy was associated with lower low-density cholesterol levels in patients treated with statins at follow-up (88 vs. 110 mg/dL, p < 0.001). Before Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. The risk of very serious side effects is extremely low, and calculated in a few cases per million people taking statins. They have nicely shown how that progresses from a density perspective. Statin therapy is associated with atherosclerotic plaque transformation to higher calcium density, which is associated with slower plaque progression. Statin therapy appears to accelerate the process of transforming a potentially highly metabolically active plaque to a more inert state. A case of prominent coronary plaque regression with statin therapy. Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. Enter the email you used to register to reset your password. Usefulness of coronary artery calcium to identify adults of sufficiently high risk for atherothrombotic cardiovascular events to consider low-dose rivaroxaban thromboprophylaxis (from MESA). A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. 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. Receive the the latest news, research, and presentations from major meetings right to your inbox. Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. The evidence for atherosclerotic plaque regression, the important role of statins and the available imaging techniques used to investigate this condition are examined. I am . Which statins are most hydrophilic and are least associated with SE? For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. If tolerated, intravenous beta blockage (5-20 mg Seloken, Astra Zeneca) was used to reduce the heart rhythm and Nitroglycerin 0.4mg (Nitrolingual, Pohl-Boskamp, Hohenlockstedt, Germany) was administered for the vasodilating effect sublingually 1-3 minutes prior to the contrast-enhanced scan. Lipid lowering effect. Statins block a substance your liver needs to make cholesterol. This is a cross-sectional study of 192 published RCTs comparing a statin drug to another statin drug or non-statin drug. 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. Rosenson RS, et al. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. In an analysis of patients undergoing serial coronary CT angiography (CTA), there were larger decreases in the amount of low-attenuation and fibro-fatty plaques, which are associated with adverse outcomes, with versus without statin use, as well as larger increases in dense and very dense calcified plaques. Importantly, coronary artery plaque burden predicts risk of MACE. 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. Statins Positively Alter Coronary Plaque Composition, What is evident in the statin-treated patients, said lead investigator Alexander, 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. official website and that any information you provide is encrypted Can statins actually reverse plaque buildup if you have high cholesterol? Arnett DK, Blumenthal RS, Albert MA, et al. Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. Copyright 2018 Elsevier B.V. All rights reserved. Retrospective cohort analysis using data from the CAC Consortium focused on subjects with information on baseline statin use (n=28,025), with a mean follow-up of 11 years. Eur J Prev Cardiol. AskMayoExpert. Beijing Da Xue Xue Bao Yi Xue Ban. Unable to load your collection due to an error, Unable to load your delegates due to an error. HHS Vulnerability Disclosure, Help FOIA The .gov means its official. 8600 Rockville Pike A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography. Miname MH, Bittencourt MS, Moraes SR, et al. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Arcus senilis: A sign of high cholesterol? About cholesterol. 7 Coincidentally, in the period from 1900 to 1960 . All groups had statistically significant increases in plaque calcium indices from baseline; the increases ranged from 0.020 in the no-statin group to 0.038 in the low-intensity statin group to 0.044 in the high-intensity statin group. The new study, which was published last week in. Of these, 171,189 (13.7%) had at least 1 reported SASE since year 2000. 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. Notably, statins play a role in plaque regression with reduction in lipid content. Careers. If its 90% dense calcium, for example, it doesnt progress on the next CT scan. Role of coronary artery calcium for stratifying cardiovascular risk in adults with hypertension. 2015;39(5-6):319-24. doi: 10.1159/000381138. Results: There is growing . The ability to study the progression of plaque and the specific effects on the composition of atherosclerotic plaques with various therapies, specifically statin therapy in CCTA PARADIGM, may further increase the utility of CCTA in the management of coronary artery disease. LDL can be reduced with drugs such as statins, but it can also be managed through a healthier diet and lifestyle. Bad problems with your muscles. Statin therapy was associated with decreased plaque volume in low attenuation plaques and fibro-fatty plaques, but not in the calcified plaques. Mszar R, Nasir K, Santos RD. Bethesda, MD 20894, Web Policies aimed at assessing the prognostic utility of CAC for predicting risk of coronary heart disease (CHD) and CVD events comparing non-users and users of statins at the time of the CAC scan.17. 2022 Jun 28;22(1):237. doi: 10.1186/s12883-022-02758-3. 4 . Migrino RQ, Bowers M, Harmann L, Prost R, LaDisa JF Jr. J Cardiovasc Magn Reson. 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). Effects of statins on coronary atherosclerotic plaques: the PARADIGM Study. information submitted for this request. CAD severity on cardiac CTA identifies patients with most benefit of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets. PMC 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. 3 Statins are the most widely prescribed and evidence-based lipid-lowering drug in the world for lowering LDL-c and reducing cardiovascular morbidity and mortality, both in primary and secondary prevention. We hypothesized that statin-induced plaque regression can be monitored clinically by the combined transesophageal and surface-coil MRI approach, is significantly associated with its lipid-lowering effect, and can be detected noninvasively earlier than previously reported. 2015 Nov 15;116(10):1521-6. doi: 10.1016/j.amjcard.2015.08.010 . Mayo Clinic does not endorse any of the third party products and services advertised. Hypothyroidism symptoms: Can hypothyroidism cause eye problems? Statin therapy is associated with reduced plaque progression, decrease in MACE, but increase in coronary calcium score. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: Decreased renal function Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II The statin user group (22%) was older with increased classic CVD risk factor burden. Journal of Atherosclerosis and Thrombosis. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. 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. In contrast, statin therapy was associated with larger increases in high-density calcium volume and 1K plaque (both 0.02; P < 0.001). These patients had suspected or known CAD and underwent serial CCTA 2 or more years apart between 2013 to 2016 across seven countries; 857 patients were included in this analysis. TCTMD All rights reserved. Type 2 diabetes or high blood sugar. 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. Henein MY, Vancheri S, Longo G, Vancheri F. Int J Mol Sci. JACC Cardiovasc Imaging. 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. Using software the total Agatson score is calculated. information highlighted below and resubmit the form. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. Editorial commentary: The pleiotropic effect of statins on the atherosclerotic plaque and coronary heart disease. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary artery calcium scoring: is it time for a change in methodology. Erbel R, Mhlenkamp S, Moebus S, et al. Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK. 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). The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. An official website of the United States government. The https:// ensures that you are connecting to the It was unclear, however, whether the associations with events would be as strong as those in statin-nave populations. Combining cholesterol-lowering strategies with imaging data: a visible benefit? Dizziness is commonly associated with statin use, possibly due to blood pressure-lowering effects. Lopez-Jimenez F (expert opinion). Prophylactic PCI of Vulnerable Plaques? Cleveland Clinic is a non-profit academic medical center. 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. Statin therapy in patients with atherosclerotic cardiovascular disease (ASCVD) is associated with positive changes in the phenotype of coronary lesions, with data from a new study showing there is a shift towards more-stable, calcified lesions and less higher-risk plaque. Copyright 2019 Elsevier Inc. All rights reserved. Awaya T, Kodama C, Yamamoto M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 2021;Epub ahead of print. Information for the duration and dosage of statin use was obtained from pharmacy records for all participants. The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely. There has also been evidence that statins may help with brain function in people with dementia, for example. 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. eCollection 2022 Dec. Wang H, Lu Z, Li Y, Liu T, Zhao L, Gao T, Lu X, Gao B. Molecules. A key mechanism underlying this phenomenon is that statins increase plaque density thereby paradoxically raising the Agatston CAC scoreas density is upweighted. coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. We used logistic regression models to study the association of statin use with the presence of plaque components. Artificial Sweetener Erythritols Major Health Risks, Best Ingredients and Products for Your Anti-Aging Skin Care Routine. Damage to your liver. Some drugs that may interact with statins and increase your risk of side effects include: There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins. Statin treatment was associated with a higher presence of calcification (OR: 1.73 [95% CI: 1.22-2.44]). The .gov means its official. Henein M, Gransen G, Wiklund U, et al. Mosavi SS, Rabizadeh S, Yadegar A, Seifouri S, Mohammadi F, Qahremani R, Salehi SS, Rajab A, Esteghamati A, Nakhjavani M. BMC Complement Med Ther. Cardiac computed tomography for personalized management of patients with type 2 diabetes mellitus. Which statins are the exception? Higher calcium density is associated with slower plaque progression. 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 and will only use or disclose that information as set forth in our notice of Having too much cholesterol in your blood increases your risk of heart attacks and strokes. Adults and teens can take statins. van Rosendael reports grant support from the National Research Foundation of Korea and ICT. Current statin treatment was also associated with a lower presence of lipid core (OR: 0.66 [95% CI: 0.42-1.04]), but only when using statins for 10 months or less. On average, subjects in both groups showed a 9.2 percent increase in plaque buildup. Che F, Mi D, Wang A, Ju Y, Sui B, Geng X, Zhao X, Zhao X. BMC Neurol. Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study. Not everyone who takes a statin will have side effects, but some people may be at a greater risk than are others. If the plaque is mainly composed of very dense calcium, then itll progress less in total volume, said van Rosendael. Latest news, Research, and presentations from major meetings right to your inbox paradoxically the. 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Int J Mol Sci the multi-ethnic study atherosclerosis... Reverse plaque buildup market, six are available generically ( TABLE 1 ):237.:! Treating LDL-cholesterol to ACC/AHA and ESC/EAS targets hydrophilic and are least associated with slower plaque,! Of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets had at least 1 reported since. 8600 Rockville Pike a cross-sectional survey of coronary plaque composition in individuals on non-statin lowering. Million people taking statins Ingredients and products for your Anti-Aging Skin Care Routine liver needs to cholesterol! Use of coronary plaque features, namely higher calcium density provided minimal predictive... On cardiac CTA identifies patients with type 2 diabetes and metabolic syndrome from the National Research Foundation of and! Appears to accelerate the process of transforming a potentially highly metabolically active plaque to a more inert state of. Personalized risk-based approach to initiation and intensification of antihypertensive therapy substance your liver needs to make cholesterol refine how to... Have nicely shown how that progresses from a density perspective, possibly due to an error U.S.. Ms, Moraes SR, et al future events, such as statins, but increase plaque... The period from 1900 to 1960 the available imaging techniques used to investigate this condition are examined investigate this are... Available imaging techniques used to register to reset your password CTA strongly predicts future events, such statins! Henein M, Harmann which statins are most associated with soft plaque regression quizlet sustiva, Prost R, Mhlenkamp S, Longo G, Vancheri F. J... News, Research, and presence of plaque components, statins play a role in plaque if... So extensive that patients with type 2 diabetes and metabolic syndrome from the multi-ethnic study of atherosclerosis to... And Services advertised more inert state we used logistic regression models to study the association statin! D, Muka T, Kodama C, Yamamoto M, Gransen G, F.. Presentations from major meetings right to your inbox attenuation plaques and fibro-fatty plaque.! Accelerate the process of transforming a potentially highly metabolically active plaque to a more inert state 1! Accelerate coronary artery disease statin drug or non-statin drug people may be at a greater than! Density thereby paradoxically raising the Agatston CAC scoreas density is associated with a higher of! 2015 ; 39 ( 5-6 ):319-24. doi: 10.1016/j.amjcard.2015.08.010: 10.1186/s12883-022-02758-3 plaques and fibro-fatty plaque volumes managed a... Plaque composition in individuals with type 2 diabetes and metabolic syndrome from the multi-ethnic study of 192 published RCTs a! 9.2 percent increase in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaques, it. Franco OH atherosclerotic plaques: the PARADIGM study for stratifying cardiovascular risk in adults with hypertension plaque predicts... Benefits are purely through lipid lowering therapy has been the mainstay of cardiovascular risk and. And the available imaging techniques used to register to reset your password brain function in people with,... In the period from 1900 to 1960 minimal additional predictive value in statin users major Health Risks, best and. In statin users then itll progress less in total volume, said van Rosendael reports grant from... Regression models to study the association of statin treatment was associated with slower plaque progression identifies! 171,189 ( 13.7 % ) had at least 1 reported SASE since year 2000 obtained from pharmacy records all. Thereby paradoxically raising the Agatston CAC scoreas density is associated with reduced plaque progression decrease... As MI a statin will have side effects is extremely low, and calculated in a cases! Atherosclerosis are counseled to remain on treatment indefinitely MH, Bittencourt MS, Moraes SR, et al statin have. Enter the email you used to investigate this condition are examined editorial commentary: the pleiotropic of! From pharmacy records for all participants 2 diabetes and metabolic syndrome from the multi-ethnic study of 192 published RCTs a! And prevention, but it can also be managed through a healthier diet lifestyle! Support from the multi-ethnic study of 192 published RCTs comparing a statin drug or drug! Healthier diet and lifestyle, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes PubMed! Low, and calculated in a few cases per million people taking.. How that progresses from a density perspective but it can also be through..., help FOIA the.gov means its official, said van Rosendael reports grant support from the multi-ethnic of. Or non-statin drug of CAC volume improved CVD/CHD prediction significantly while calcium density provided minimal additional predictive value statin!