Statins appear to increase density of calcium in atherosclerotic plaque

Reuters Health - 31/08/2021 -  A fresh look at the effect of statin therapy appears to confirm prior research suggesting the drugs reduce low-density plaque, while increasing the densification of calcium, thereby creating more stable plaque, according to new findings.

"The study shows that if there is plaque present in the coronary arteries, statins are able to reduce the high-risk, noncalcified, part of the plaque, while slightly transforming a bit into very dense calcium. This is a process that is likely associated with decreased risk for plaque destabilization," Dr. Alexander van Rosendael of Leiden University Medical Center, in the Netherlands, told Reuters Health by email.

He and his colleagues examined more than 2,400 lesions in 857 patients from a pool of more than 2,000 enrolled in PARADIGM, a three-year study spanning 13 sites in seven countries. In a subgroup analysis, they compared computed tomography scans of patients receiving statins with untreated patients, noting the density and quantity of plaques at baseline and follow-up two to three years later.

The study included six categories of plaque: from low-attenuation plaque at a density of -30 to 75 Hounsfield units to 1k plaques, which were calcified, high-density plaques of more than 1,000 Hounsfield units.

Untreated lesions grew, increasing plaques in all six density groups, the researchers report in JAMA Cardiology. In patients taking statins, however, the researchers found statistically significant decreases in the two lowest-density plaque categories and increases in the two highest-density plaque categories. Changes in the two middle-density plaques were not significant.

Digging deeper, an analysis of plaques composed only of the four higher-density types at baseline found that statins did not appear to change their volume. Instead, the plaques became denser.

"Using serial coronary CTA imaging, the paper nicely confirms the notion that progressive calcification of atherosclerotic disease is associated with plaque stabilization, which, in turn, is associated with less progression," said Dr. Armin Zadeh, associate professor of medicine at Johns Hopkins University Division of Cardiology in Baltimore, Maryland, who was not involved in the research.

"Statin therapy accelerates this process, presumably by cooling down plaque inflammation. Since calcified plaque volume is commonly overestimated vs. noncalcified disease using current generation CTA, the effects seem to offset each other, leading to apparent lack of plaque volume regression with statin use. The study findings suggest that this indeed is an artifact of the image analysis," Dr. Zadeh told Reuters Health by email.

SOURCE: https://bit.ly/3gPSwOl JAMA Cardiology, online August 18, 2021.

By Rob Goodier



Posted on 31 August 20219 September 2021