Effects of Statins on Coronary Atherosclerotic Plaques The PARADIGM Study

被引：404

作者：

Lee, Sang-Eun ^{[1
,2
]}

Chang, Hyuk-Jae ^{[1
,2
]}

Sung, Ji Min ^{[1
,2
]}

Park, Hyung-Bok ^{[2
,3
]}

Heo, Ran ^{[2
,4
]}

Rizvi, Asim ^{[5
,6
]}

Lin, Fay Y. ^{[5
,6
]}

Kumar, Amit ^{[5
,6
]}

Hadamitzky, Martin ^{[7
]}

Kim, Yong Lin ^{[8
]}

Conte, Edoardo ^{[9
]}

Andreini, Daniele ^{[9
]}

Pontone, Gianluca ^{[9
]}

Budoff, Matthew J. ^{[10
]}

Gottlieb, Ilan ^{[11
]}

Lee, Byoung Kwon ^{[12
]}

Chun, Eun Ju ^{[13
]}

Cademartiri, Filippo ^{[14
]}

Maffei, Erica ^{[15
]}

Marques, Hugo ^{[16
]}

Leipsic, Jonathon A. ^{[17
]}

Shin, Sanghoon ^{[18
]}

Choi, Jung Hyun ^{[19
]}

Chinnaiyan, Kavitha ^{[20
]}

Raff, Gilbert ^{[20
]}

Virmani, Renu ^{[21
]}

Samady, Habib ^{[22
]}

Stone, Peter H. ^{[23
]}

Berman, Daniel S. ^{[24
]}

Narula, Jagat ^{[25
,26
]}

Shaw, Leslee J. ^{[22
]}

Bax, Jeroen J. ^{[27
]}

Min, James K. ^{[5
,6
]}

机构：

[1] Yonsei Univ, Yonsei Univ Hlth Syst, Severance Cardiovasc Hosp, Div Cardiol,Coll Med, Seoul, South Korea

[2] Yonsei Univ, Yonsei Univ Hlth Syst, Yonsei Cedars Sinai Integrat Cardiovasc Imaging R, Coll Med, Seoul, South Korea

[3] Catholic Kwandong Univ, Int St Marys Hosp, Dept Internal Med, Div Cardiol, Incheon, South Korea

[4] Univ Ulsan, Coll Med, Asan Med Ctr, Div Cardiol, Seoul, South Korea

[5] New York Presbyterian Hosp, Dalio Inst Cardiovasc Imaging, New York, NY USA

[6] Weill Cornell Med Coll, New York, NY USA

[7] German Heart Ctr Munich, Dept Radiol & Nucl Med, Munich, Germany

[8] Seoul Natl Univ, Seoul Natl Univ Hosp, Coll Med, Seoul, South Korea

[9] IRCCS, Ctr Cardiol Monzino, Milan, Italy

[10] Los Angeles Biomed Res Inst, Dept Med, Torrance, CA USA

[11] Casa Saude Sao Jose, Dept Radiol, Rio De Janeiro, Brazil

[12] Yonsei Univ, Gangnam Severance Hosp, Coll Med, Seoul, South Korea

[13] Seoul Natl Univ, Bundang Hosp, Seoul, South Korea

[14] SDN Fdn IRCCS, Cardiovasc Imaging Ctr, Naples, Italy

[15] Area Vasta 1 ASUR Marche, Dept Radiol, Urbino, Italy

[16] Hosp Luz, UNICA, Unit Cardiovasc Imaging, Lisbon, Portugal

[17] Univ British Columbia, Dept Med & Radiol, Vancouver, BC, Canada

[18] Natl Hlth Insurance Serv Ilsan Hosp, Goyang, South Korea

[19] Busan Univ Hosp, Busan, South Korea

[20] William Beaumont Hosp, Dept Cardiol, Royal Oak, MI 48072 USA

[21] CVPath Inst, Dept Pathol, Gaithersburg, MD USA

[22] Emory Univ, Sch Med, Div Cardiol, Atlanta, GA 30322 USA

[23] Brigham & Womens Hosp, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA

[24] Cedars Sinai Med Ctr, Dept Imaging & Med, Los Angeles, CA 90048 USA

[25] Icahn Sch Med Mt Sinai, Mt Sinai Heart, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA

[26] Marie Josee & Henry R Kravis Ctr Cardiovasc Hlth, New York, NY USA

[27] Leiden Univ, Dept Cardiol, Med Ctr, Leiden, Netherlands

来源：

JACC-CARDIOVASCULAR IMAGING | 2018年 / 11卷 / 10期

基金：

美国国家卫生研究院; 新加坡国家研究基金会;

关键词：

coronary artery atherosclerosis; coronary artery disease; coronary computed tomography angiography; statins; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; CT ANGIOGRAPHY; MYOCARDIAL-INFARCTION; SCCT GUIDELINES; PROGRESSION; EVENTS; THERAPY; CALCIUM; IMPACT; RISK;

D O I：

10.1016/j.jcmg.2018.04.015

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 >= 2years. 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. (C) 2018 by the American College of Cardiology Foundation.

引用

页码：1475 / 1484

页数：10

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