Effects of Statins on Coronary Atherosclerotic Plaques The PARADIGM Study
Effects of Statins on Coronary Atherosclerotic Plaques The PARADIGM Study
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DOI：
10.1016/j.jcmg.2018.04.015
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发表时间：
2018-10-01
影响因子：
14
通讯作者：
Min, James K.
中科院分区：
文献类型：
--
作者：
Lee, Sang-Eun;Chang, Hyuk-Jae;Min, James K.
本研究试图描述他汀类药物对个体冠状动脉粥样硬化斑块的影响。背景虽然他汀类药物降低主要不良心血管事件的风险，但其对冠状动脉粥样硬化的长期影响尚不清楚。一项多国研究，包括在一次扫描中接受连续冠状动脉计算机断层扫描血管造影的无冠状动脉疾病史的连续患者登记研究间隔>= 2年。对动脉粥样硬化斑块的直径狭窄百分比（%DS）、动脉粥样硬化体积百分比（PAV）、斑块成分和高危斑块（HRP）的存在进行定量分析，高危斑块（HRP）的定义为存在≥ 2个低衰减斑块、正性动脉重塑或点状钙化特征。（60 +/- 9岁; 57%男性），在他汀类药物初治患者（n = 474）中评价了1，079处冠状动脉病变，在他汀类药物服用患者（n = 781）中评价了2，496处冠状动脉病变。与他汀类药物初治患者的病变相比，他汀类药物治疗患者的病变显示出更慢的总体PAV进展速率（分别为每年1.76 +/- 2.40%和每年2.04 +/- 2.37%; p = 0.002），但钙化PAV的进展更快（分别为每年1.27 +/- 1.54% vs.每年0.98 +/- 1.27%; p < 0.001）。在他汀类药物治疗患者的病变中，非钙化PAV的进展和新HRP特征的年发生率较低（分别为0.49 ± 2.39%/年vs. 1.06 ± 2.42%/年和0.9%/年vs. 1.6%/年;均p < 0.001）。进展至> 50%DS的比率没有差异（分别为1.0%和1.4%; p > 0.05）。他汀类药物与21%的年化总PAV进展以上的中位数和35%的减少HRP development.CONCLUSIONS他汀类药物与整体冠状动脉粥样硬化体积进展缓慢，增加斑块钙化和减少高危斑块的特点。他汀类药物不影响冠状动脉病变狭窄程度的进展，但诱导表型斑块转化。(C)2018年由美国心脏病学会基金会。
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.