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. Artificial Sweetener Erythritols Major Health Risks, Best Ingredients and Products for Your Anti-Aging Skin Care Routine. Williams MC, Kwiecinski J, Doris M, et al. There is now overwhelming evidence to support reducing LDL-c (low-density lipoprotein cholesterol) to reduce atherosclerotic cardiovascular disease (CVD). Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. 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. To relieve side effects believed to be caused by statins, your doctor may recommend several options. Low-attenuation noncalcified plaque on coronary computed tomography angiography predicts myocardial infarction: results from the multicenter SCOT-HEART trial (Scottish Computed Tomography of the HEART). Statins and coronary artery calcium: what's the score? 8600 Rockville Pike The coronary artery calcium (CAC) burden as reported with the Agatston score1 is strongly associated with adverse cardiovascular disease (CVD) events.2-6 CAC scoring using the Agatston method is an established guideline-endorsed adjunct to traditional risk factors for enhanced risk assessment to guide management in asymptomatic individuals.7-9. The risk of very serious side effects is extremely low, and calculated in a few cases per million people taking statins. Even if your side effects are frustrating, don't stop taking your statin medication for any period of time without talking to your doctor first. the unsubscribe link in the e-mail. 2015 Nov 15;116(10):1521-6. doi: 10.1016/j.amjcard.2015.08.010 . For more information, visit http://www.crf.org. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. Unauthorized use of these marks is strictly prohibited. Higher calcium density is associated with slower plaque progression. J Cardiovasc Comput Tomogr. In SCOT-HEART, low-attenuation plaque was a better predictor of future events than other commonly used measures, such as a cardiovascular risk score, coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. We do not endorse non-Cleveland Clinic products or services. Therapeutic effects of resveratrol and Omega-3 in mice atherosclerosis: focus on histopathological changes. Moving forward, we discuss approaches to further enhance preventive therapy allocation in statin users undergoing CAC testing. Che F, Mi D, Wang A, Ju Y, Sui B, Geng X, Zhao X, Zhao X. BMC Neurol. Targets for plaque stabilization LDL cholesterol and cardiovascular events. Miname MH, Bittencourt MS, Moraes SR, et al. Awaya T, Kodama C, Yamamoto M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr. 2011 Aug 3;13(1):37. doi: 10.1186/1532-429X-13-37. van Rosendael AR, Narula J, Lin FY, et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely. Counterintuitively, however, coronary calcium scores continue to increase with statin therapy but probably at a slower rate.2 Furthermore, the presence of very dense calcium (>1000 Hounsfield units, or 1K) seems to be associated with lower rates of major events for a specific plaque.3,4 Therefore, delineating the effects of statin therapy on plaque composition may help guide risk estimation and management decisions for patients with CAD. Shemesh J, Apter S, Itzchak Y, Motro M. Coronary calcification compared in patients with acute versus in those with chronic coronary events by using dual-sector spiral CT. Henein M, Gransen G, Wiklund U, et al. Statin side effects Weigh the benefits and risks, Advertising and sponsorship opportunities, Taking multiple medications to lower your cholesterol, Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS), Amiodarone (Cordarone, Pacerone), a medication for irregular heart rhythms, Gemfibrozil (Lopid), another variety of cholesterol drug, HIV treatments called protease inhibitors such as saquinavir (Invirase) and ritonavir (Norvir), Some antibiotic and antifungal medications, such as clarithromycin and itraconazole (Onmel, Sporanox), Some immunosuppressant medications, such as cyclosporine (Gengraf, Neoral, Sandimmune). Greenland P, Blaha MJ, Budoff MJ, Erbel R, Watson KE. Accessed Jan. 24, 2019. Would you like email updates of new search results? Doctors target smaller, unstable plaque. The progression of atherosclerotic plaque composition has been previously described with intravascular ultrasound and CCTA. 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. Cholesterol: Top foods to improve your numbers, Cholesterol-lowering supplements may be helpful. The .gov means its official. 2022 May 27;13:899241. doi: 10.3389/fendo.2022.899241. Due to this small change in plaque volume, other effects of statin therapy on plaques have been proposed . McEvoy JW, Martin SS, Dardari ZA, et al. Despite the well-documented improved survival of coronary heart disease with the use of statins, their effects on atherosclerotic plaques are not yet fully understood. Doctors often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke. 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. This is a cross-sectional study of 192 published RCTs comparing a statin drug to another statin drug or non-statin drug. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. Miedema MD, Duprez DA, Misialek JR, et al. Notably, statins play a role in plaque regression with reduction in lipid content. Statin therapy leads to reduced plaque progression, likely representing a central mechanism for its favorable clinical effect. Introduction: Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the foremost commonly endorsed medications in cardiac patients. Cholesterol test kits: Are they accurate? Usefulness of coronary artery calcium to identify adults of sufficiently high risk for atherothrombotic cardiovascular events to consider low-dose rivaroxaban thromboprophylaxis (from MESA). Clipboard, Search History, and several other advanced features are temporarily unavailable. Nakazato R, Gransar H, Berman DS, et al. PMC We know that there are different compositions of the plaque, he said. Hypothyroidism: Can calcium supplements interfere with treatment? Nicholls said there is now evidence showing that a number of plaque characteristics on imaging, such as low-attenuation plaques on CTA, lipid burden on near-infrared spectroscopy (NIRS), and fibrous cap thickness and the presence of lipid-rich plaques on optical coherence tomography (OCT), are all associated with adverse outcomes. We aimed to investigate the association of statin treatment with the presence of different plaque components located in the carotid arteries within a population-based setting. Finally, an alternative approach to overcome the density paradox could be to expand the use of alternative CAC scoring methods that focus on volume alone or better distinguish the protective role of densely calcified plaque.32 However, this is hampered by a current lack of reference values, limited supportive research, and validation; implementation limitations include software update requirements and standardization. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. 2018;12:757. There has also been evidence that statins may help with brain function in people with dementia, for example. 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). http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.VpbEathIiic. Type 2 diabetes or high blood sugar. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). It remains uncertain whether statin /ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. Enter the email you used to register to reset your password. 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. TCTMD All rights reserved. Budoff MJ, Muhlestein JB, Bhatt DL, Le Pa VT, May HT, Shaikh K, Shekar C, Kinninger A, Lakshmanan S, Roy SK, Tayek J, Nelson JR. Cardiovasc Res. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; P = 0.03) but markedly lower in follow-up (88 vs 110 mg/dL; P < 0.001). Cleveland Clinic is a non-profit academic medical center. 2023 Apr 4;24(7):6723. doi: 10.3390/ijms24076723. coronary artery calcium (CAC), Agatston units, and presence of obstructive coronary artery disease. [Association of statin treatment with progression of coronary atherosclerotic plaque composition. Before Accessed Jan. 24, 2019. Please enable it to take advantage of the complete set of features! Models adjusted for atheroma volume showed that changes in calcium indices were significantly greater in both . astatin on plaque regression in untreated intermediate coro-nary stenosis in Korean patients. Information for the duration and dosage of statin use was obtained from pharmacy records for all participants. 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 FDA warns on statin labels that some people have developed memory loss or confusion while taking statins. On the flip side, van Rosendael previously showed that the presence of very dense coronary plaque. government site. High dose and long-term statin therapy accelerate coronary artery calcification. This difference in mortality rate blunts the association for statin users compared to nonusers; however, absolute increases in mortality rate are similar with increasing CAC score (Table 1). official website and that any information you provide is encrypted You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Epub 2022 Jun 23. Fluvastatin 3. They do that not only by shrinking plaques, but by promoting an increase in calcification, said Nicholls. Beijing Da Xue Xue Bao Yi Xue Ban. Meta-analysis comparing the effects of rosuvastatin versus atorvastatin on regression of coronary atherosclerotic plaques Am J Cardiol. 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. If you think you're experiencing side effects from statins, don't just stop taking the pills. Of the seven different statins on the market, six are available generically ( TABLE 1 ). Copyright 2023. 8600 Rockville Pike Rosuvastatin 2. The https:// ensures that you are connecting to the Atorvastatin and simvastatin are the most effective at reducing LDL cholesterol levels. The study by Osei 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. Past 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. Components of the score including volume, area, and density were quantified. This site needs JavaScript to work properly. Not everyone who takes a statin will have side effects, but some people may be at a greater risk than are others. Criqui MH, Denenberg JO, Ix JH, et al. Damage to your kidneys. Mayo Clinic, Rochester, Minn. March 18, 2019. Puri R, Nicholls SJ, Shao M, et al. Statins represent a key treatment for cardiovascular disease. Rarely, if the increase is severe, you may need to try a different statin. 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 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). Statin therapy is associated with atherosclerotic plaque transformation to higher calcium density, which is associated with slower plaque progression. While CAC scores are a strong predictor of future events, the score incorporates both calcified and noncalcified plaques. Given the similar improvement in prognostic value compared to risk factor only models (Table 2) and similar increases in absolute mortality rates, the attenuation of HR does not limit the clinical utility of using CAC scores for risk stratification in statin users.17. I am . Atherosclerosis refers to the buildup of plaque in the arteries that are normally responsible for carrying blood to various vital organs of the body. 2023 American College of Cardiology Foundation. Nature Reviews Cardiology. It is well known that lowering the low-density lipoprotein cholesterol (LDL-C) level is useful in both the primary and secondary prevention of cardiovascular events (16-18).Statins are the most common therapeutic agents for lipid-lowering ().The major effect of statins is the reduction of LDL-C levels through the . An official website of the United States government. Peng AW, Mirbolouk M, Orimoloye OA, et al. Statins: Actions, side effects and administration. Epub 2018 Aug 7. Any dosage of statins was associated with a higher presence of calcification, whilst only high dosages (DDD > 1.33) were associated with a lower presence of lipid core. Statin users had higher baseline CAC scores (281 vs. 107) with larger mean CAC area and density. Statins block a substance your liver needs to make cholesterol. eCollection 2022. von Krchten R, Lorbeer R, Mller-Peltzer K, Rospleszcz S, Storz C, Askani E, Kulka C, Schuppert C, Rathmann W, Peters A, Bamberg F, Schlett CL, Mujaj B. Nutrients. CCTA has improved clinicians' ability to treat patients with CAD by identifying patients with at least mild coronary atherosclerotic disease; this may result in earlier implementation of treatment to reduce ASCVD risk with pharmacotherapy. Al'Aref SJ, Su A, Gransar H, van Rosendael AR, Rizvi A, Berman DS, Callister TQ, DeLago A, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff GL, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Leipsic J, Feuchtner G, Pontone G, Andreini D, Marques H, de Arajo Gonalves P, Rubinshtein R, Achenbach S, Chang HJ, Chow BJW, Cury R, Lu Y, Bax JJ, Jones EC, Pea JM, Shaw LJ, Min JK, Lin FY. Statin intolerance. Foods such as butter (but only if it's grass-fed), cheeses, fatty red meats (e.g. The actual risk of developing muscle pain as a result of taking statins is about 5 percent or less compared with taking a pill that doesn't contain medication (placebo). There is calcified and noncalcified plaque, and it looks like the calcified part of the plaque does have less prognostic value than the noncalcified plaque.. information highlighted below and resubmit the form. 2022 Nov 17;84:104846. doi: 10.1016/j.amsu.2022.104846. Cholesterol medications: Consider the options. Moving forward, expanded use of enhanced CAC scoring systems and, most importantly, early initiation of multiple risk-reduction medications, may bypass the plaque density paradox and enhance primary ASCVD protection for patients. The .gov means its official. Methods and Findings. Unable to load your collection due to an error, Unable to load your delegates due to an error. Clinical studies using ultrasound in the coronary arteries have shown that when you are on high doses of these medicines, even if you have plaque buildup already, you can stabilize the plaque on statin therapy. The German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. Bookshelf Antioxidants (Basel). Min JK, Dunning A, Lin FY, et al. Lipid lowering effect. Whether these benefits are purely through lipid lowering or pl Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. Alonso R, et al. National Library of Medicine Higher calcium density is associated with slowed plaque progression. government site. 64 In the ASTEROID 65 and SATURN studies, 66 aggressive lipid lowering regressed atheroma volume in IVUS. Adhyaru BB, et al. van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Some considerations can help clinicians deal with this paradox. Disclaimer. There have been several clinical studies many of them done here at Cleveland Clinic thatshow statins can reverse plaque buildup. At the upcoming European Society of Cardiology Congress 2021, Nicholls is presenting data from the HUYGENS study, which is an OCT investigation into changes in atherosclerotic plaque composition among ACS patients treated with statins and the PCSK9 inhibitor evolocumab (Repatha; Amgen). ](Source Hyperlinks https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117 ) JAMA Cardiol. Their total cholesterol and reduce their risk of a heart attack or.., search History, and calculated in a few cases per million taking! Role in plaque volume, other effects of resveratrol and Omega-3 in mice:., Shao M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput.! Of plaques significantly increased after 12 months compared with non-statin-based lipid lowering therapy has been the of... Health Risks, Best Ingredients and Products for your Anti-Aging Skin Care Routine SJ! R, Nicholls SJ, Shao M, et al for people with high to! 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