Impact of Statins on Serial Coronary Calcification During Atheroma Progression and Regression
Open accessAbstract
Background Statins can regress coronary atheroma and lower clinical events. Although pre-clinical studies suggest procalcific effects of statins in vitro, it remains unclear if statins can modulate coronary atheroma calcification in vivo. Objectives This study compared changes in coronary atheroma volume and calcium indices (CaI) in patients receiving high-intensity statin therapy (HIST), low-intensity statin therapy (LIST), and no-statin therapy. Methods In a post-hoc patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound, serial changes in coronary percent atheroma volume (PAV) and CaI were measured across matched coronary segments in patients with coronary artery disease. Results Following propensity-weighted adjustment for differences in baseline and changes in clinical, laboratory, and ultrasonic characteristics, HIST (n = 1,545) associated with PAV regression from baseline (-0.6 ± 0.1%; p < 0.001), whereas both LIST (n = 1,726) and no-statin therapy (n = 224) associated with PAV progression (+0.8 ± 0.1% and +1.0 ± 0.1%; p < 0.001, respectively; p < 0.001 for both HIST vs. LIST and HIST vs. no-statin; p = 0.35 for LIST vs. no-statin). Significant increases in CaI from baseline were noted across all groups (median [interquartile range] HIST, +0.044 [0.0-0.12]; LIST, +0.038 [0.0-0.11]; no-statin, +0.020 [0.0-0.10]; p < 0.001 for all), which could relate to statin intensity (p = 0.03 for LIST vs. no-statin; p = 0.007 for HIST vs. no-statin; p = 0.18 for HIST vs. LIST). No correlations were found between changes in CaI and on-treatment levels of atherogenic and antiatherogenic lipoproteins, and C-reactive protein, in either of the HIST groups or the no-statin group. Conclusions Independent of their plaque-regressive effects, statins promote coronary atheroma calcification. These findings provide insight as to how statins may stabilize plaque beyond their effects on plaque regression.
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The use of statins can promote calcification of atherosclerotic plaques.
“Recent studies demonstrated that the use of statins can promote calcification of atherosclerotic plaques 29, 48 .”
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- Authors
- Puri, R., Nicholls, S. J., Shao, M., Kataoka, Y., Uno, K., Kapadia, S. R., Tuzcu, E. M., & Nissen, S. E.
- Affiliations
- Cleveland Clinic (US)
- South Australian Health and Medical Research Institute (AU)
- Corresponding author
- Nissen, Steven E.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 65
- Issue
- 13
- Pages
- 1273-1282
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2121363804
- Cited by
- 571
- References
- 1
- Citations by year
- 2026: 32 · 2025: 30 · 2024: 44 · 2023: 49 · 2022: 56 · 2021: 69 · 2020: 66 · 2019: 50 · 2018: 57 · 2017: 39 · 2016: 58 · 2015: 20
- FWCI
- 58.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Amgen
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Anthera
- Novo Nordisk
- Esperion Therapeutics
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- statins, high-intensity statin therapy, coronary artery disease, intravascular ultrasound, plaque stabilization, lipoproteins, C-reactive protein, atheroma progression, atheroma regression
- MeSH terms
- Aged, Calcium, Coronary Artery Disease, Coronary Vessels, Female, Humans, Male, Middle Aged, Prospective Studies, Ultrasonography, Interventional, Disease Progression, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Plaque, Atherosclerotic, Vascular Calcification
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