Abstract
Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM. In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent 18F-fluorodeoxyglucose positron emission tomographic/computed tomographic imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (18F-fluorodeoxyglucose uptake, expressed as target-to-background ratio) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced computed tomographic angiography was performed to characterize the presence of HRM (defined as noncalcified or partially calcified plaques) in the LMCA. Arterial inflammation (target-to-background ratio) was higher in LMCA segments with HRM than those without HRM (mean±SEM: 1.95±0.43 versus 1.67±0.32 for LMCA with versus without HRM, respectively; P=0.04). Moreover, atorvastatin treatment for 12 weeks reduced target-to-background ratio more in LMCA segments with HRM than those without HRM (12 week-baseline Δtarget-to-background ratio [95% confidence interval]: -0.18 [-0.35 to -0.004] versus 0.09 [-0.06 to 0.26]; P=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline low-density lipoprotein and statin dose (β=-0.27; P=0.038). In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain HRM features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00703261.
Highlights
Nonobstructive coronary plaques manifesting high-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events
It is well accepted that the presence of nonobstructive atherosclerotic plaques, those with high-risk morphological (HRM) features, is associated with an increased risk of future cardiovascular disease events.[1,2]
Statins Reduce Left Main Coronary Artery Inflammation, an Effect More Pronounced Within Advanced Coronary Lesions We evaluated the impact of statin therapy on left main coronary artery (LMCA) and observed that after 12 weeks of statin therapy, FDG uptake was reduced in LMCA with HRM but not in LMCA without HRM (12-week baseline change in TBR [95% confidence interval]: −0.18 [−0.35 to −0.004] versus 0.09 [−0.06 to 0.26]; P=0.02; Figure 4)
Summary
This study is part of a larger randomized double-blind trial that was conducted at 10 US centers to investigate the impact of atorvastatin therapy on arterial wall inflammation. The protocol was reviewed and approved by each center’s institutional review board, and all participants provided written informed consent before any study procedures. Analysis of FDG uptake in the LMCA, carotid arteries, and aorta was performed before unblinding of the data. We used computed tomographic angiography (CTA) images and performed a blinded analysis of plaque composition in carotids and coronary arteries and assessed the relationship between FDG uptake and high-risk plaque morphology. The primary end point of the study, evaluating the effect of statin therapy on large-vessel inflammatory activity (assessed by FDG PET/CT), was previously reported.[9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
