Abstract 16913: Greater Coronary Atheroma Regression in Women Compared With Men: A Pooled Analysis of Serial Intravascular Ultrasonography Trials Utilizing High-intensity Statin Therapy

Introduction: High-intensity statin therapy (HIST) reduces cardiovascular events, however sex-related differences in treatment effects are not well characterized, possibly contributing to gender disparities in HIST use. Hypothesis: Sex-related differences in coronary atheroma regression exist following HIST. Methods: We undertook a patient-level post-hoc pooled analysis of 3 randomized trials utilizing serial coronary IVUS to test the anti-atherosclerotic effects of HIST in patients with coronary disease. Sex-related differences in changes (Δ) in coronary percent atheroma volume (PAV) were ascertained following 18-24 months of either atorvastatin 80 mg or rosuvastatin 40 mg. Results: In women (n=451) compared with men (n=1190), levels of on-treatment LDL-C (68±24 vs. 68±22mg/dl, p=0.62) were similar, however HDL-C (53±12 vs. 47±11 mg/dl, p<0.01) and CRP [1.7 (0.9, 3.8) vs. 1.1 (0.6, 2.7) mg/l, p<0.01] were higher. Compared with men, women harbored lower baseline PAV (34.8±8.7 vs. 38.3±8.8%, p<0.001), yet demonstrated greater PAV regression (ΔPAV -1.07±0.26 vs. -0.66±0.23%, p=0.02). When achieved on-treatment LDL-C levels were <70mg/dl, women demonstrated greater PAV regression than men (-1.49±0.21 vs. -0.97±0.13%, p=0.035), however had similar rates of PAV regression with on-treatment LDL-C levels ≥70 mg/dl (-0.63±0.25 vs. -0.42±0.16%, p=0.47). Sex-related differences in atheroma regression did not differ according to achieved levels of HDL-C, non-HDL-C or CRP (Figure). Multivariable analysis revealed female sex to independently associate with PAV regression (coefficient -0.66, p=0.017). Conclusion: Women systematically demonstrate greater degrees of coronary plaque regression compared with men following long-term HIST, especially in the setting of lower achieved LDL-C levels. Further research is required for elucidating mechanisms underpinning sex-related variations in plaque progression-regression.

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Abstract 13849: Impact of Statin-Ezetimibe Combination on Coronary Atheroma Progression/Regression in Patients With and Without Prior Statin Therapy - Subanalysis of PRECISE-IVUS Trial

Circulation ◽

10.1161/circ.132.suppl_3.13849 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Kenichi Tsujita ◽

Kenshi Yamanaga ◽

Seigo Sugiyama ◽

Hideki Shimomura ◽

Takuro Yamashita ◽

...

Keyword(s):

Statin Therapy ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Coronary Intervention ◽

Cholesterol Absorption ◽

Coronary Plaque ◽

Regression Effect ◽

Atheroma Volume ◽

Plaque Regression ◽

Coronary Atheroma

Introduction: IMPROVE-IT trial showed the clinical benefit of statin-ezetimibe (EZE) combination appeared to be pronounced in patients with prior statin therapy. On the other hand, the PRECISE-IVUS ( P laque RE gression with C holesterol absorption I nhibitor or S ynthesis inhibitor E valuated by I ntra V ascular U ltra S ound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile. Hypothesis: We hypothesized that the antiatherosclerotic effect of atorva-EZE combination was pronounced in patients with statin pretreatment. Methods: 246 patients undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination or atorva alone. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients. We compared the IVUS endpoints in all subjects, stratified by the presence of statin pretreatment. Results: The baseline LDL-C level (100.7±23.1mg/dL vs. 116.4±25.9mg/dL, p<0.001) and lathosterol (55 [38 to 87])μg/100mg TC vs. 97 [57 to 149]μg/100mg TC, p<0.001) was significantly lower, and campesterol/lathosterol ratio (3.9 [2.4 to 7.4] vs. 2.6 [1.5 to 4.1], p<0.001) was significantly accelerated in patients with statin pretreatment. Contrary to the patients without statin pretreatment (-1.3 [-3.1 to -0.1]% vs. -0.9 [-2.3 to 0.9]%, p=0.12), the atorva-EZE combination showed the significantly stronger reduction in delta percent atheroma volume, compared with atorva alone, in patients with statin pretreatment (-1.8 [-3.6 to -0.3]% vs. -0.1 [-1.6 to 0.8]%, p=0.002). Conclusions: Compared to atorva alone, atorva-EZE combination demonstrated stronger regression effect in coronary atheroma volume especially in patients with statin pretreatment. Compensatory accelerated cholesterol absorption might be associated with reduced coronary plaque regression. Low-dose statin-EZE combination might be a promising option in statin-hyporesponder.

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Coronary atheroma progression rates in men and women following high-intensity statin therapy: A pooled analysis of REVERSAL, ASTEROID and SATURN

Atherosclerosis ◽

10.1016/j.atherosclerosis.2016.09.059 ◽

2016 ◽

Vol 254 ◽

pp. 78-84 ◽

Cited By ~ 12

Author(s):

Brian Stegman ◽

Mingyuan Shao ◽

Stephen J. Nicholls ◽

Mohamed Elshazly ◽

Leslie Cho ◽

...

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Pooled Analysis ◽

Men And Women ◽

Coronary Atheroma

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Effects of statin therapy on coronary plaque volume by decreasing CRP/hsCRP levels: A meta-regression of randomized controlled trials

10.1101/2021.12.26.21268412 ◽

2021 ◽

Author(s):

Darui Gao ◽

Rong Hua ◽

Dina Jiesisibieke ◽

Yanjun Ma ◽

Chenglong Li ◽

...

Keyword(s):

Statin Therapy ◽

Meta Analysis ◽

Coronary Plaque ◽

Plaque Volume ◽

Percent Change ◽

Randomized Controlled ◽

Atheroma Volume ◽

Plaque Regression ◽

Meta Regression ◽

Meta Regression Analysis

Background and aims: Several clinical trials have indicated that statins stabilize and reverse atherosclerotic plaque. However, different studies have provided inconsistent findings regarding mechanisms and influencing factors of plaque regression under statin therapy. In this study, meta-analysis and meta-regression were used to determine the effect of statin medication on coronary plaque volume as determined by intravenous ultrasound. Meanwhile, the impact of statins on CRP/hsCRP reduction on plaque regression was discussed. Methods: Up to May 28, 2021, a systematic PubMed, EMBASE, and Cochrane search was performed for randomized controlled trials that assessed treatment effect using total atheroma volume (TAV), percent atheroma volume (PAV), or plaque volume (PV). Only CRP/hsCRP and LDL-C values reported before and after treatment were considered. Results: 12 studies fulfilled the inclusion criteria and were included in the systematic review. Compared with control groups, meta-analysis of 15 statin-treated arms reported change of TAV/PV showed standardized mean difference (SMD) at -0.27 (95% confidence intervals [CI]: -0.42, -0.12). Meta-analysis of 7 studies reported change of PAV revealed SMD at -0.16 (95% CI: -0.29, -0.03). Meta-regression analysis revealed percent change of CRP/hsCRP statistically influences SMD in change of TAV/PVafter adjusting for percent change of LDL-C, age and gender. Meta-regression analysis showed that percent change of CRP/hsCRP statistically influences SMD in change of PAV. Conclusion: In conclusion, statin therapy is beneficial for plaque regression. Statins promote plaque regression through their anti-inflammatory ability while lowering LDL-C is unaffected. Keywords: Statins; Reduction of atherosclerosis; C-reactive protein; Randomized controlled trial; Meta-analysis

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Abstract 623: Effect of High-intensity Statin Therapy on High-density Lipoprotein (HDL) Subfractions and Regression of Coronary Atheroma: The SATURN Trial

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.623 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Ron C Hoogeveen ◽

Mingyuan Shao ◽

Kathy Wolski ◽

Rishi Puri ◽

Christie M Ballantyne ◽

...

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Density Lipoprotein ◽

Treated Group ◽

Hdl Subfractions ◽

Beneficial Effects ◽

Apo E ◽

Atheroma Volume ◽

Artery Disease ◽

Coronary Atheroma

Aim: Statin therapy can slow the progression of coronary atherosclerosis. However, the clinical factors underlying the beneficial effects of statin therapy on disease progression remain poorly understood. We examined the relationship of circulating HDL subfractions with measures of coronary atheroma following long-term high-intensity statin therapy. Methods: Serial coronary intravascular ultrasound (IVUS) was utilized in SATURN to monitor changes in atheroma burden [percent atheroma volume (PAV)] in 915 patients with coronary artery disease, treated with rosuvastatin (40 mg) or atorvastatin (80 mg) daily for 24 months. Results: Baseline levels of total HDL-C, apo E-containing HDL-C (apoE HDL-C), HDL 3 -C and HDL 2 -C did not differ significantly between treatment groups. Compared with the atorvastatin-treated group, rosuvastatin-treated patients demonstrated greater increases in levels of total HDL-C (4.4% vs. -1.8%, p<0.001), apoE HDL-C (8.5% vs. -3.3%, p<0.001), HDL 3 -C (3.3% vs. -2.7%, p<0.001) and HDL 2 -C (7.0% vs. -0.7%, p<0.001). The alterations in apo E HDL-C and HDL 3 -C levels were associated with PAV regression in rosuvastatin-treated patients (β=-0.84, p=0.018 and β=-1.10, p=0.056, respectively) but not in the atorvastatin-treated group (β=0.41, p=0.22 and β=0.71, p=0.22 for apo E HDL-C and HDL 3 -C, respectively). Conclusions: Rosuvastatin therapy resulted in favorable changes in HDL subfractions and on-treatment levels of apoE HDL-C and HDL 3 -C were associated with greater disease regression.

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Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4)

JACC Cardiovascular Imaging ◽

10.1016/j.jcmg.2018.08.024 ◽

2019 ◽

Vol 12 (8) ◽

pp. 1518-1528 ◽

Cited By ~ 11

Author(s):

Lorenz Räber ◽

Konstantinos C. Koskinas ◽

Kyohei Yamaji ◽

Masanori Taniwaki ◽

Marco Roffi ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Statin Therapy ◽

High Intensity ◽

Coronary Plaque ◽

Plaque Composition

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Coronary Plaque Regression After Statin Therapy

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.06.423 ◽

2018 ◽

Vol 27 ◽

pp. S230-S231

Author(s):

A. May ◽

L. Lin

Keyword(s):

Statin Therapy ◽

Coronary Plaque ◽

Plaque Regression

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Abstract 3211: Diabetes is Associated with Greater Progression of Coronary Atherosclerosis than the Metabolic Syndrome: Insights from Serial Intravascular Ultrasound Studies

Circulation ◽

10.1161/circ.118.suppl_18.s_1113-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

O Bayturan ◽

T Hu ◽

P Schoenhagen ◽

S Kapadia ◽

E.M Tuzcu ◽

...

Keyword(s):

Metabolic Syndrome ◽

Disease Progression ◽

Intravascular Ultrasound ◽

Coronary Atherosclerosis ◽

Similar Degree ◽

Progression Rate ◽

The Metabolic Syndrome ◽

Atheroma Volume ◽

Plaque Regression ◽

Coronary Atheroma

Background: While the metabolic syndrome (MetS) and diabetes (DM) share many pathophysiological features it remains to be determined if they influence coronary atherosclerotic disease progression to a similar degree. Methods : A systematic review of subjects participating in 7 clinical trials that monitored coronary atheroma progression with intravascular ultrasound was performed. Clinical characteristics, baseline atheroma burden and disease progression were compared in patients with the MetS (n=1119), DM (n=201) or their combination (n=878). Results: Patients with the MetS were younger, more likely to be female and had a greater risk factor burden than diabetics. At baseline the presence of DM was associated with a greater percent atheroma volume (PAV 41.0+/−8.5 vs 37.6+/−8.9 %, p<0.001) and total atheroma volume (TAV 202.5+/−84.1 vs 190.73+−84.9 mm 3 , p<0.001) than observed in patients with the MetS. Greater progression of PAV (+0.71+/−0.3 vs 0.28+/−0.2 % p=0.04) and TAV (−3.3+/−1.8 vs −1.0+/−2.1 mm 3 , p=0.1) was observed in the presence of DM compared with the MetS. The combination of MetS and DM was not associated with greater PAV (+0.82+/−0.2 vs +0.71+/−0.3 %, p=0.59) or TAV (−1.0+/−1.8 vs −1.0+/−2.1 mm 3 , p=0.98) than DM alone. Substantial progression rate were not differ between three groups (Table ). However, the combination of DM and the MetS did result in the lowest rate of patients undergoing substantial plaque regression (>.0 % chg in PAV, 14.9% vs 18.4%, p=0.01) when compared with patients with DM, not meeting the criteria for the MetS. Conclusions: Despite the presence of more risk factors, meeting the criteria for the MetS is not associated with a greater rate of progression of coronary atherosclerosis in patients with DM. This highlights the accelerated nature of disease in the setting of established DM. Table. Baseline and changes in IVUS disease burden according to metabolic syndrome and diabetes

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