Increases in coronary artery calcium score (CACS) detect changes in coronary plaque burden and composition differently in statin-treated and statin-naive patients, according to a study published in the European Heart Journal-Cardiovascular Imaging.
A total of 654 patients from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) study, a multinational observational registry, were included in the study. Investigators included only consecutive patients who had data on statin use (statin-taking [n=408] and non-statin [n=246] groups) and who had undergone serial coronary computed tomography angiography at a ≥2-year interval.
Coronary computed tomography angiographies measured CACS, and coronary plaque volumes (total, calcified, and noncalcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analyzed.
Using multivariate linear regression models, the researchers compared statin-taking and nonstatin groups with regard to the compositional change in plaque volume (PV) and CACS. An increase in CACS in the nonstatin group was positively associated with noncalcified (β=0.369; P =.004) and calcified (β=1.579; P <.001) PV increase.
An increase in CACS in the statin-taking group positively correlated with calcified PV change (β=0.756; P <.001) and negatively correlated with noncalcified PV change (β=−0.194; P =.026).
Limitations of the study include its observational design and the smaller-than-expected cohort, and that researchers were unable to stratify the association between CACS and PV according to the intensity of statin treatment.
The findings suggest “that the presence of statins needs to be considered when interpreting the results of serial CACS and highlights the necessity of future prospective studies evaluating the effect of statins on CACS progression and its impact on clinical outcomes,” concluded the researchers.
Disclosures: Several authors disclosed affiliations with pharmaceutical companies. See the reference for complete disclosure information.
Lee SE, Sung JM, Andreini D, et al. Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study [published online February 20, 2019]. Eur Heart J Cardiovasc Imaging. doi: 10.1093/ehjci/jez022