Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study

Sang Eun Lee, Hyuk Jae Chang, Ji Min Sung, Hyung Bok Park, Ran Heo, Asim Rizvi, Fay Y. Lin, Amit Kumar, Martin Hadamitzky, Yong Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J. Budoff, Ilan Gottlieb, Byoung Kwon Lee, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo MarquesJonathon A. Leipsic, Sanghoon Shin, Jung Hyun Choi, Kavitha Chinnaiyan, Gilbert Raff, Renu Virmani, Habib Samady, Peter H. Stone, Daniel S. Berman, Jagat Narula, Leslee J. Shaw, Jeroen J. Bax, James K. Min

Research output: Contribution to journalArticle

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Abstract

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 ≥2 years. 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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)

Original languageEnglish
Pages (from-to)1475-1484
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume11
Issue number10
DOIs
Publication statusPublished - 2018 Oct

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Atherosclerotic Plaques
Coronary Artery Disease
Coronary Vessels
Coronary Stenosis
Risk Reduction Behavior
Registries
Angiography
Pathologic Constriction
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Sang Eun ; Chang, Hyuk Jae ; Sung, Ji Min ; Park, Hyung Bok ; Heo, Ran ; Rizvi, Asim ; Lin, Fay Y. ; Kumar, Amit ; Hadamitzky, Martin ; Kim, Yong Jin ; Conte, Edoardo ; Andreini, Daniele ; Pontone, Gianluca ; Budoff, Matthew J. ; Gottlieb, Ilan ; Lee, Byoung Kwon ; Chun, Eun Ju ; Cademartiri, Filippo ; Maffei, Erica ; Marques, Hugo ; Leipsic, Jonathon A. ; Shin, Sanghoon ; Choi, Jung Hyun ; Chinnaiyan, Kavitha ; Raff, Gilbert ; Virmani, Renu ; Samady, Habib ; Stone, Peter H. ; Berman, Daniel S. ; Narula, Jagat ; Shaw, Leslee J. ; Bax, Jeroen J. ; Min, James K. / Effects of Statins on Coronary Atherosclerotic Plaques : The PARADIGM Study. In: JACC: Cardiovascular Imaging. 2018 ; Vol. 11, No. 10. pp. 1475-1484.
@article{61952074e27242078d951249892ae59a,
title = "Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study",
abstract = "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 ≥2 years. 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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)",
author = "Lee, {Sang Eun} and Chang, {Hyuk Jae} and Sung, {Ji Min} and Park, {Hyung Bok} and Ran Heo and Asim Rizvi and Lin, {Fay Y.} and Amit Kumar and Martin Hadamitzky and Kim, {Yong Jin} and Edoardo Conte and Daniele Andreini and Gianluca Pontone and Budoff, {Matthew J.} and Ilan Gottlieb and Lee, {Byoung Kwon} and Chun, {Eun Ju} and Filippo Cademartiri and Erica Maffei and Hugo Marques and Leipsic, {Jonathon A.} and Sanghoon Shin and Choi, {Jung Hyun} and Kavitha Chinnaiyan and Gilbert Raff and Renu Virmani and Habib Samady and Stone, {Peter H.} and Berman, {Daniel S.} and Jagat Narula and Shaw, {Leslee J.} and Bax, {Jeroen J.} and Min, {James K.}",
year = "2018",
month = "10",
doi = "10.1016/j.jcmg.2018.04.015",
language = "English",
volume = "11",
pages = "1475--1484",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "10",

}

Lee, SE, Chang, HJ, Sung, JM, Park, HB, Heo, R, Rizvi, A, Lin, FY, Kumar, A, Hadamitzky, M, Kim, YJ, Conte, E, Andreini, D, Pontone, G, Budoff, MJ, Gottlieb, I, Lee, BK, Chun, EJ, Cademartiri, F, Maffei, E, Marques, H, Leipsic, JA, Shin, S, Choi, JH, Chinnaiyan, K, Raff, G, Virmani, R, Samady, H, Stone, PH, Berman, DS, Narula, J, Shaw, LJ, Bax, JJ & Min, JK 2018, 'Effects of Statins on Coronary Atherosclerotic Plaques: The PARADIGM Study', JACC: Cardiovascular Imaging, vol. 11, no. 10, pp. 1475-1484. https://doi.org/10.1016/j.jcmg.2018.04.015

Effects of Statins on Coronary Atherosclerotic Plaques : The PARADIGM Study. / Lee, Sang Eun; Chang, Hyuk Jae; Sung, Ji Min; Park, Hyung Bok; Heo, Ran; Rizvi, Asim; Lin, Fay Y.; Kumar, Amit; Hadamitzky, Martin; Kim, Yong Jin; Conte, Edoardo; Andreini, Daniele; Pontone, Gianluca; Budoff, Matthew J.; Gottlieb, Ilan; Lee, Byoung Kwon; Chun, Eun Ju; Cademartiri, Filippo; Maffei, Erica; Marques, Hugo; Leipsic, Jonathon A.; Shin, Sanghoon; Choi, Jung Hyun; Chinnaiyan, Kavitha; Raff, Gilbert; Virmani, Renu; Samady, Habib; Stone, Peter H.; Berman, Daniel S.; Narula, Jagat; Shaw, Leslee J.; Bax, Jeroen J.; Min, James K.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 10, 10.2018, p. 1475-1484.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effects of Statins on Coronary Atherosclerotic Plaques

T2 - The PARADIGM Study

AU - Lee, Sang Eun

AU - Chang, Hyuk Jae

AU - Sung, Ji Min

AU - Park, Hyung Bok

AU - Heo, Ran

AU - Rizvi, Asim

AU - Lin, Fay Y.

AU - Kumar, Amit

AU - Hadamitzky, Martin

AU - Kim, Yong Jin

AU - Conte, Edoardo

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Budoff, Matthew J.

AU - Gottlieb, Ilan

AU - Lee, Byoung Kwon

AU - Chun, Eun Ju

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Marques, Hugo

AU - Leipsic, Jonathon A.

AU - Shin, Sanghoon

AU - Choi, Jung Hyun

AU - Chinnaiyan, Kavitha

AU - Raff, Gilbert

AU - Virmani, Renu

AU - Samady, Habib

AU - Stone, Peter H.

AU - Berman, Daniel S.

AU - Narula, Jagat

AU - Shaw, Leslee J.

AU - Bax, Jeroen J.

AU - Min, James K.

PY - 2018/10

Y1 - 2018/10

N2 - 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 ≥2 years. 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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)

AB - 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 ≥2 years. 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. (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging [PARADIGM]; NCT02803411)

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DO - 10.1016/j.jcmg.2018.04.015

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