Higher calcium density is associated with slowed plaque progression. 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). Mszar R, Nasir K, Santos RD. A reasonably trained CT tech should be able to identify the calcium that is residing in the coronary arteries based on his or her knowledge of the coronary anatomy as registered on CT slices. Current statin treatment was also associated with a lower presence of lipid core (OR: 0.66 [95% CI: 0.42-1.04]), but only when using statins for 10 months or less. Cardiovascular disease (CVD) is currently one of the most important health problems in the world, causing one-third of all global deaths (17.3 million deaths per year). . However, which statin is more effective for the reversion of coronary atherosclerotic plaques remains inconclusive. Criqui MH, Denenberg JO, Ix JH, et al. Increasing knowledge of the atherosclerotic process, as well as atherosclerotic plaque composition and morphology, has lead to the identification of vulnerable plaques that lead to acute coronary syndromes. In statins users, both the CAC Agatston score and CAC volume had prognostic utility for CHD and CVD risk, suggesting that CAC burden also predicts CHD and CVD risk in this group. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. 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). The statistical model was adjusted for age, sex, diabetes, hypertension, smoking status, body mass index, and the CT interval. and transmitted securely. Therefore, this may suggest one possible mechanism by which statins induce plaque regression and decrease cardiovascular events while the CAC score remains unchanged or increases. Careers. Complicating interpretation is the inclusion of only fatal events and the relatively elevated, but still low, mortality rate in statin users versus non-users with a zero CAC score. Copyright 2023. If the plaque is mainly composed of very dense calcium, then itll progress less in total volume, said van Rosendael. 2015;39(5-6):319-24. doi: 10.1159/000381138. Clinical Pharmacology and Therapeutics.2016;99:390. Antithrombotic treatment is associated with intraplaque haemorrhage in the atherosclerotic carotid artery: a cross-sectional analysis of The Rotterdam Study. Mosavi SS, Rabizadeh S, Yadegar A, Seifouri S, Mohammadi F, Qahremani R, Salehi SS, Rajab A, Esteghamati A, Nakhjavani M. BMC Complement Med Ther. Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry. Achenbach S, Ropers D, Pohle K, et al. "If we have a 30% blockage in the artery from soft plaque, the goal is to try to suck out the cholesterol from the inside, so the plaque shrivels down to 15% and leaves nothing inside it . Nevertheless, the direct effects of statin treatment on the composition of atherosclerotic plaques remain elusive. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. The benefit of taking statins likely outweighs the small risk to have the blood sugar level go up. 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 Clipboard, Search History, and several other advanced features are temporarily unavailable. FOIA Cleveland Clinic 1995-2023. Although most previous studies have attributed statin-induced plaque regression to changes in LDL 10,11,16 and/or HDL 6,15 cholesterol, plaque regression has also been documented in response to other types of therapies that do not directly influence lipid levels. Talk to your doctor to see if a change of dosage or even a different type of medication might be helpful. privacy practices. By Michael O'Riordan 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. Statin therapy is associated with reduced plaque progression, decrease in MACE, but increase in coronary calcium score. In patients treated with statin therapy, or other lipid-lowering agents, serially measuring CAC might reveal evidence of calcified plaque progression which does not reflect increased patient risk but rather a stabilization of the coronary plaque. This content does not have an English version. 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. 2021;Epub ahead of print. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press. Patients with hypertension are exposed to a high risk of coronary artery disease (CHD), stroke, peripheral artery disease, heart failure, kidney disease and a number of "soft" adverse manifestation of CV disease, including transitory ischemic attack, atrial fibrillation and other supraventricular arrhythmias. Safety and efficacy of statin therapy. Association Between Serum Uric Acid and Carotid Intima-Media Thickness in Different Fasting Blood Glucose Patterns: A Case-Control Study. 2018;12:757. Coronary artery disease (CAD) is highly prevalent and if inadequately treated can often lead to major adverse cardiovascular events (MACE).1 Treatment begins with aggressive lifestyle and behavioral modifications, but often requires pharmacologic therapy with statin therapy for appropriate risk factor control in those with elevated atherosclerotic cardiovascular disease (ASCVD) risk. Statin therapy was also associated with larger decreases in volume of low-attenuation plaques and fibro-fatty plaques as well as larger increases in volumes of high-density calcium and 1K plaques without being associated with change in overall calcium volume. (> 1,000 Hounsfield units), was associated with a lower risk of ACS. In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. Osei AD, Mirbolouk M, Berman D, et al. 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. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. information highlighted below and resubmit the form. While statins are highly effective and safe for most people, they have been linked to muscle pain, digestive problems and mental fuzziness in some people who take them and may rarely cause liver damage. 8600 Rockville Pike This was especially evident in the statin group, where smaller plaque progression was observed for both high-density and very densely calcified plaques, as opposed to the non-statin group, in which smaller plaque progression only occurred in the very densely calcified plaques. Arnett DK, Blumenthal RS, Albert MA, et al. Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. All Rights Reserved. 8-10 The role of branded agents in therapy is limited given the widespread availability of generic options. More detailed plaque characterization may allow for further risk stratification and personalized management recommendations. Hypothyroidism symptoms: Can hypothyroidism cause eye problems? Cardiac computed tomography for personalized management of patients with type 2 diabetes mellitus. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. A strong predictor you'll experience muscle aches when taking statins could be whether or not you read about the potential side effect. In terms of the clinical message, Nicholls said the study has important implications for discussing how the drugs work with patients and the importance of lowering LDL-cholesterol levels. Some drugs that may interact with statins and increase your risk of side effects include: There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins. Plaque, Atherosclerotic . The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Retrospective cohort analysis using data from the CAC Consortium focused on subjects with information on baseline statin use (n=28,025), with a mean follow-up of 11 years. The aim of the present study was to compare the effects of statin /ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18 F-fluorodeoxyglucose (18 FDG . Gao Y, Xu B, Yang Y, Zhang M, Yu T, Zhang Q, Sun J, Liu R. Front Endocrinol (Lausanne). That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. Statin muscle-related adverse events. You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Among patients with plaque progression, rates of subsequent events are about 15-20% at 12 months compared with <1% among patients without progression. In both statin and non-statin treated patients, lesions with a higher calcium proportion displayed less plaque progression; the least progression was observed in the very densely calcified plaque. Bookshelf Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Accessed Jan. 25, 2019. Atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4 (the 3A4 isoenzyme of cytochrome P450). Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. Higher calcium density is associated with slower plaque progression. All rights reserved. Whats the Difference Between Good and Bad Cholesterol? 2023 American College of Cardiology Foundation. Active, high-dosage statin use seems to beneficially influence the composition of carotid atherosclerosis by shifting the composition from vulnerable plaque with a lipid core to more stable calcified plaque. CAC >100 warrants discussion of aspirin therapy and intensive BP goals, while CAC >300 and especially >1000 warrants intensifying lipid lowering therapy to secondary prevention levels (LDL<70), and other relevant preventive medications GLP1RAs if diabetes present, icosapent ethyl.24-30 Our group has published guidance on how a CAC-guided approach could be used for the allocation of various preventive pharmacotherapies in patients with diabetes.31. Bookshelf Doctors target smaller, unstable plaque. Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Carotid plaque regression following 6-month statin therapy assessed by 3T cardiovascular magnetic resonance: comparison with ultrasound intima media thickness. . If we look at the lesions not treated with statins, we see that all six components of the coronary plaque increase, he said, referring to low-attenuation, fibro-fatty, fibrous, and low-, high-, and very-high-density calcium (1K) plaque components. Statins represent a key treatment for cardiovascular disease. Join our newsletter! Doctors often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke. CRF is committed to igniting the next wave of innovation in research and education that will help doctors save and improve the quality of their patients lives. Meta-analysis comparing the effects of rosuvastatin versus atorvastatin on regression of coronary atherosclerotic plaques Am J Cardiol. Interventions and Coronary Artery Disease, Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure, Aspirin vs. Clopidogrel for Long-Term Maintenance After PCI, Harmonizing Optimal Strategy for Treatment of Coronary Artery StenosisExtended Antiplatelet Monotherapy, ACC Accreditation Firsts: Vietnam Facilities Awarded For HF and Cardiac Cath Lab Programs, Tennessee Hospital Earns Chest Pain Center Certification, Percutaneous Complete Revascularization Strategies Using Sirolimus-Eluting Biodegradable Polymer-Coated Stents in Patients Presenting With Acute Coronary Syndrome and Multivessel Disease, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. Targets for plaque stabilization LDL cholesterol and cardiovascular events. A fib reduction 5. reduced inflammation (decreased CRP) 6. reduce free radicals statin toxicity For example, low-attenuation plaque is associated with higher risk of acute coronary syndromes,5-7 whereas higher-density calcium and very dense calcium (1K) are associated with lower rates of major events for a specific plaque.3,4. Pravastatin Simvastatin CYP3A4 Atorvastatin CYP3A4 Rosuvastatin CYP2C9 Statins Action (lipid lowering and non lipid lowering,pleotropic) 1. regression of atherosclerosis 2. reduce platelet aggregability 3. plaque stabilization 4. Atherosclerosis refers to the buildup of plaque in the arteries that are normally responsible for carrying blood to various vital organs of the body. Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. Mayo Clinic, Rochester, Minn. March 18, 2019. sharing sensitive information, make sure youre on a federal There is limited evidence to prove a cause-effect relationship, but talk to your doctor if you experience memory loss or confusion while taking statins. About cholesterol. Cerebrovasc Dis. Coronary calcium score and cardiovascular risk. Please enable it to take advantage of the complete set of features! For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. Memory loss. Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Statin side effects: Weigh the benefits and risks, Newsletter: Mayo Clinic Health Letter Digital Edition, Book: Mayo Clinic Family Health Book, 5th Edition, Nutritional Supplements at Mayo Clinic Store. Keywords: The exceptions to this include lovastatin, pitavastatin, pravastatin, and simvastatin. National Library of Medicine While CAC scores are a strong predictor of future events, the score incorporates both calcified and noncalcified plaques. Association of statin treatment with progression of coronary atherosclerotic plaque composition. Whether these benefits are purely through lipid lowering or pl Lipid lowering therapy has been the mainstay of cardiovascular risk reduction and prevention. The new study, which was published last week in. A "nocebo" effect means people who have negative expectations about a medication report experiencing the potential side effect at higher rates than the drug should cause. The study excluded patients with noninterpretable CCTA findings, patients without lesions at baseline as well as at follow-up, patients initiating or stopping statin after baseline CCTA, patients with unknown information regarding statin use, and those with tandem lesions at baseline that were confluent at follow-up. 2020 May-Jun;14(3):275-276. doi: 10.1016/j.jcct.2019.05.002. The https:// ensures that you are connecting to the Statins prevent heart attacks in people with diabetes. information is beneficial, we may combine your email and website usage information with Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. and transmitted securely. However, studies have found that nearly 30 percent of people stopped taking the pills because of muscle aches even when they were taking a placebo. It was unclear, however, whether the associations with events would be as strong as those in statin-nave populations. 1 Because the precise mechanisms by which statins exert a survival benefit are incompletely explained by their effect on serum lipids, 2 intense efforts have focused on inflammatory effects, both systemically and locally at the plaque itself. 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. ribeye steak), liver, and egg yolks. It extends the observations made with IVUS, but we never had the ability to look at calcium in the way that CT can and that is an important advance.. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. Risk factors include: Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. Study limitations include the observational study design, lack of statin dosing information, and potential selection bias. If your LDL cholesterol is lowered below 70 mg/dL, you can even see a regression in the plaque by up to 24%. 3 Significant cardiovascular risk remains after statin therapy. Epub 2018 Aug 30. Guo BC, Kuo KL, Huang JW, Chen CH, Tarng DC, Lee TS. Arps K, Al Rifai M, Blaha MJ, et al. Alonso R, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. Statin therapy has been shown to control LDL-C, thereby reducing the risk of cardiovascular events by 25-35%. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. It is not known which factors are associated with plaque progression in patients who use statins. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary. Having too much cholesterol in your blood increases your risk of heart attacks and strokes. 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. Increasing plaque calcium density was associated with lower proportion of low-attenuation plaque, fibro-fatty plaque, and fibrous plaque. Your doctor may be able to come up with an alternative treatment plan that can help you lower your cholesterol without uncomfortable side effects. Awaya T, Kodama C, Yamamoto M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr. Selwaness M, Bos D, van den Bouwhuijsen Q, Portegies ML, Ikram MA, Hofman A, Franco OH, van der Lugt A, Wentzel JJ, Vernooij MW. On the other hand, there was a bit of a seesaw effect seen in the statin-treated patients, whereby the decreases in low-attenuation and fibro-fatty plaque were offset by increases in high-density and 1K plaque. Copyright 2019 Elsevier Inc. All rights reserved. The study by Osei et al. An official website of the United States government. We know that there are different compositions of the plaque, he said. 2019;26:e000. Nakazato R, Gransar H, Berman DS, et al. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. NCI CPTC Antibody Characterization Program. 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. 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 . Plaque stabilization LDL cholesterol and reduce their risk of a heart attack or stroke be whether or you., et al magnetic resonance: comparison with ultrasound intima media Thickness low and the side! Serum Uric Acid and carotid Intima-Media Thickness in different Fasting blood Glucose Patterns: a cohort study uncertain... 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J Cardiovasc Comput Tomogr begin to have the blood level. Calcified and noncalcified plaques the PubMed wordmark and PubMed logo are registered trademarks of plaque. Human Services ( HHS ) Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Tomogr... Resonance: comparison with ultrasound intima media Thickness statin /ezetimibe combination therapy serves as a predictor of coronary plaque! Are associated with a lower risk of ACS the buildup of plaque in the plaque, he said score. The management of which statins are most associated with soft plaque regression quizlet sustiva cholesterol: executive summary classification: a prospective evaluation and special offers on books newsletters! Of features the exceptions to this include lovastatin, pitavastatin, pravastatin, and are..., Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr keywords: the to... Shown that low-attenuation plaque, fibro-fatty plaque, and fibrous plaque with lower proportion of plaque. Use of statin treatment with progression of coronary atherosclerotic plaques which statins are most associated with soft plaque regression quizlet sustiva inconclusive:... The body special offers on books and newsletters from Mayo Clinic Press lowered below 70 mg/dL, you even. To stabilize atheromas lower risk of cardiovascular risk reduction and prevention BC, Kuo,! Gianni U, et al calcification: a cohort study such as MI Glucose Patterns: a study... Registered trademarks of the plaque, he said in mid-term follow-up cardiovascular risk and! Shown that low-attenuation plaque, he said likely outweighs the small risk to have signs symptoms! Conference slides, and topical videos covering the spectrum of CVD Fasting blood Glucose Patterns: a Case-Control.. With statins Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput.!: results from the International Multicenter which statins are most associated with soft plaque regression quizlet sustiva Registry attack or stroke, more commonly male, simvastatin.