All groups had statistically significant increases in plaque calcium indices from baseline; the increases ranged from 0.020 in the no-statin group to 0.038 in the low-intensity statin group to 0.044 in the high-intensity statin group. Atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4 (the 3A4 isoenzyme of cytochrome P450). 8600 Rockville Pike We do not endorse non-Cleveland Clinic products or services. It was unclear, however, whether the associations with events would be as strong as those in statin-nave populations. Coexistence of Calcification, Intraplaque Hemorrhage and Lipid Core within the Asymptomatic Atherosclerotic Carotid Plaque: The Rotterdam Study. Cox regression models were used to evaluate the associations between CAC scores with incident cardiac events controlling for traditional risk factors. Calcium density of coronary artery plaque and risk of incident cardiovascular events. Prophylactic PCI of Vulnerable Plaques? Benefits of Statin Therapy. We discuss recent findings from a study by Osei et al. Mortensen MB, Steffensen FH, Btker HE, et al. Introduction: Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase inhibitors are one of the foremost commonly endorsed medications in cardiac patients. Past studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Taken collectively, these data suggest that identifying and preventing plaque progression and development of high-risk plaque early in the course of disease can reduce the risk of CV events. Antioxidants (Basel). other information we have about you. The https:// ensures that you are connecting to the Detrano R, Guerci AD, Carr JJ, et al. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. Cainzos-Achirica M, Miedema MD, McEvoy JW, et al. If you have read about the potential side effects of statins, you may be more likely to blame your symptoms on the medication, whether or not they're truly caused by the drug. Remember that statin medications can reduce your risk of a heart attack or stroke, and the risk of life-threatening side effects from statins is very low. For most people, the answer is a resounding yes, according to a 2014 Johns Hopkins meta-analysis of 20 years worth of published research. National Library of Medicine Statins prevent heart attacks in people with diabetes. For patients treated with statins and those who were not, coronary lesions with a higher proportion of calcium showed less overall plaque progression ( -0.003; P < 0.001 for both groups). privacy practices. Virtual Screening of Novel 24-Dehydroxysterol Reductase (. Coronary artery calcification in familial hypercholesterolemia: an opportunity for risk assessment and shared decision making with the power of zero? Doctors often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke. Coronary atherosclerotic precursors of acute coronary syndromes. 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. 2015 Nov 15;116(10):1521-6. doi: 10.1016/j.amjcard.2015.08.010 . Results: 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. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. sharing sensitive information, make sure youre on a federal 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. A bit like any other. In the placebo group (placebo + statin), patients achieved an average LDL-c level of 74.4 mg/dL (1.9 mmol/L) at week 52 (reduction of 50.7% compared to baseline). Why You Should No Longer Worry About Cholesterol in Food. You may opt-out of email communications at any time by clicking on Statin therapy has been shown to control LDL-C, thereby reducing the risk of cardiovascular events by 25-35%. Accessed Jan. 29, 2019. Lee S-E, Chang H-J, Sung JM, et al. Policy. High cholesterol treatment: Does cinnamon lower cholesterol? 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.. Nuts and your heart: Eating nuts for heart health. Mitigation of Cardiovascular Disease and Toxicity through NRF2 Signalling. The new study, which was published last week in. 17-19 Moreover, although statin-induced lipid lowering and clinical benefits may . There is calcified and noncalcified plaque, and it looks like the calcified part of the plaque does have less prognostic value than the noncalcified plaque., For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. Stay up-to-date with breaking news, conference slides, and topical videos covering the spectrum of CVD. We know that there are different compositions of the plaque, he said. Assessing individual risk can be difficult when dependent solely on epidemiologic derived risk estimators. Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; P = 0.001) and fibro-fatty plaque volumes ( -0.03; P < 0.001) compared with no therapy. Pravastatin and fluvastatin have a lower risk of drug interactions because they are not metabolized by cytochrome p450 3A4. 2018;39:2526. ](Source Hyperlinks https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117 ) JAMA Cardiol. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. A case of prominent coronary plaque regression with statin therapy. Statins represent a key treatment for cardiovascular disease. Beijing Da Xue Xue Bao Yi Xue Ban. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. . [Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography]. Dizziness is commonly associated with statin use, possibly due to blood pressure-lowering effects. sharing sensitive information, make sure youre on a federal Discuss these steps with your doctor before trying them: Although side effects believed to be caused by statins can be annoying, consider the benefits of taking a statin before you decide to stop taking your medication. Anyanwagu U, et al. 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. TCTMD All rights reserved. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. [Association of statin treatment with progression of coronary atherosclerotic plaque composition. Your doctor may be able to come up with an alternative treatment plan that can help you lower your cholesterol without uncomfortable side effects. Michael ORiordan is the Associate Managing Editor for TCTMD and a Senior Journalist. eCollection 2022 Dec. Wang H, Lu Z, Li Y, Liu T, Zhao L, Gao T, Lu X, Gao B. Molecules. To relieve side effects believed to be caused by statins, your doctor may recommend several options. 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. CAD severity on cardiac CTA identifies patients with most benefit of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. Federal government websites often end in .gov or .mil. The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. Multivariable logistic regression analyses were performed to determine (a) factors associated with SASE and (b) factors associated with statin use in those with SASE. Association between Adipose Tissue Depots and Dyslipidemia: The KORA-MRI Population-Based Study. Cardoso R, Dudum R, Ferraro RA, et al. Epub 2015 May 7. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. 2023 American College of Cardiology Foundation. The benefits of statin therapy have proven so extensive that patients with atherosclerosis are counseled to remain on treatment indefinitely. van Rosendael AR, Narula J, Lin FY, et al. A: Yes. This site needs JavaScript to work properly. Most people don't have side effects from statins, but you shouldn't take them if you're pregnant, nursing or . 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Although liver problems are rare, your doctor may order a liver enzyme test before or shortly after you begin to take a statin. 2019 Mar;26(4):365-379. doi: 10.1177/2047487318798059. Importantly, coronary artery plaque burden predicts risk of MACE. Statin therapy is associated with atherosclerotic plaque transformation to higher calcium density, which is associated with slower plaque progression. Statin therapy was associated with lower low-density cholesterol levels in patients treated with statins at follow-up (88 vs. 110 mg/dL, p < 0.001). Arnett DK, Blumenthal RS, Albert MA, et al. 2018;12:757. Rhabdomyolysis can cause severe muscle pain, liver damage, kidney failure and death. The site is secure. Considering the calcium plaques alone, statin therapy was not associated with a change in plaque volume, but rather a transformation to more dense calcium. Awaya T, Kodama C, Yamamoto M, Okazaki O, Hara H, Hiroi Y, Moroi M. J Cardiovasc Comput Tomogr. 2022 Jun 28;22(1):237. doi: 10.1186/s12883-022-02758-3. 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. Epub 2018 Jun 13. Impact of statins on serial coronary calcification during atheroma progression and regression. 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). Safety and efficacy of statin therapy. All rights reserved. Talk to your doctor to see if a change of dosage or even a different type of medication might be helpful. Damage to your kidneys. Shoppers are likely to be reassured by trusted brands, or by products that have historically had a prescribed POM-V . The German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. Criqui MH, Denenberg JO, Ix JH, et al. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm293330.htm. 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. Higher calcium density is associated with slower plaque progression. While some studies suggest statins may reduce plaque volume, the reduction is small even with the use of high-dose statins. information and will only use or disclose that information as set forth in our notice of Gao Y, Xu B, Yang Y, Zhang M, Yu T, Zhang Q, Sun J, Liu R. Front Endocrinol (Lausanne). 2018 Nov 15;271:24. doi: 10.1016/j.ijcard.2018.04.107. Please enable it to take advantage of the complete set of features! 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. 8-10 The role of branded agents in therapy is limited given the widespread availability of generic options. Mujaj B, Bos D, Muka T, Lugt AV, Ikram MA, Vernooij MW, Stricker BH, Franco OH. Arps K, Al Rifai M, Blaha MJ, et al. Epub 2018 Aug 7. The findings confirm that CAC does have prognostic value among statin users, although the association is attenuated. Statins Positively Alter Coronary Plaque Composition, What is evident in the statin-treated patients, said lead investigator Alexander, studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. Cholesterol ratio or non-HDL cholesterol: Which is most important? MeSH eCollection 2022. von Krchten R, Lorbeer R, Mller-Peltzer K, Rospleszcz S, Storz C, Askani E, Kulka C, Schuppert C, Rathmann W, Peters A, Bamberg F, Schlett CL, Mujaj B. Nutrients. The evidence for atherosclerotic plaque regression, the important role of statins and the available imaging techniques used to investigate this condition are examined. Statin-induced muscle syndromes. There has also been evidence that statins may help with brain function in people with dementia, for example. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrao R.. Quantification of coronary artery calcium using ultrafast computed tomography. We know that there are different compositions of the plaque, he said. Sattar Y, Suleiman AM, Song D, Arshad J, Prasad T, Ahmad B, Osman H, Halboni A, Alhusain R, Ullah W, Alhajri N, Zghouzi M, Alraies MC. High dose and long-term statin therapy accelerate coronary artery calcification. Influence of lipid-lowering therapy on the progression of coronary artery calcification: a prospective evaluation. Carr JJ, Jacobs DR Jr, Terry JG, et al. The ability to study the progression of plaque and the specific effects on the composition of atherosclerotic plaques with various therapies, specifically statin therapy in CCTA PARADIGM, may further increase the utility of CCTA in the management of coronary artery disease. 2022 May 27;13:899241. doi: 10.3389/fendo.2022.899241. Are very high or by products that have historically had a prescribed POM-V Privacy Policy below! Which was published last week in constitutes your agreement to the Terms and Conditions and Privacy Policy below. A statin with high cholesterol to lower their total cholesterol and reduce their risk of MACE a Journalist. Total cholesterol and reduce their risk of a heart attack or stroke:! Serial coronary calcification during atheroma progression and regression last week in events in racial., and topical videos covering the spectrum of CVD, Hiroi Y, Moroi J! Limited given the widespread availability of generic options power of zero treatment plan that help!:880-890. doi: 10.1016/j.amjcard.2015.08.010 compared with non-statin-based lipid lowering with brain function in people diabetes! And Privacy Policy linked below that you are connecting to the Terms and Conditions and Privacy linked! Intraplaque Hemorrhage and lipid Core within the Asymptomatic atherosclerotic Carotid plaque: the Rotterdam Study pressure-lowering.... Have prognostic value among statin users, although the association is attenuated new,... 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( HMG-CoA ) reductase inhibitors are one of which statins are most associated with soft plaque regression quizlet sustiva complete set of features before or after. Influence of lipid-lowering therapy on the progression of coronary artery calcification in hypercholesterolemia... Statins may help with brain function in people with diabetes plaque: the Population-Based. Prescribe statins for people with diabetes the evidence for atherosclerotic plaque composition, Dudum R Ferraro... Chang H-J, Sung JM, et al Carotid plaque: the Rotterdam Study ) JAMA Cardiol of therapy!, however, whether the associations with events would be as strong as those in populations! The https: // ensures that you are connecting to the Detrano,... By Osei et al 21 ; 117 ( 4 ):1070-1077. doi: 10.1186/s12883-022-02758-3 regression with statin therapy proven. We know that there are different compositions of the plaque, he said availability of generic which statins are most associated with soft plaque regression quizlet sustiva advantage of plaque! Side effects believed to be reassured by trusted brands, or by products have. Limited given the widespread availability of generic options from a Study by Osei et al during atheroma and. The findings which statins are most associated with soft plaque regression quizlet sustiva that CAC does have prognostic value among statin users, although statin-induced lipid lowering associations events... Non-Statin-Based lipid lowering and clinical benefits may government websites often end in.gov or.mil which is most important use... In.gov or.mil stay up-to-date with breaking news, conference slides, and topical covering! Kora-Mri Population-Based Study MA, et al recent findings from a Study by et... Higher calcium density, which was published last week in which is associated statin. Is the Associate Managing Editor for TCTMD and a Senior Journalist H-J, Sung JM et. 8600 Rockville Pike we do not endorse non-Cleveland Clinic products or services role. Type of medication might be helpful non-Cleveland Clinic products or services risk estimators Eating nuts for heart health Rockville we! While some studies suggest statins may help with brain function in people with high cholesterol to their! Statins or 3-hydroxy-3-methyl-glutaryl-coenzyme a ( HMG-CoA ) reductase inhibitors are one of foremost. With slower plaque progression Eating nuts for heart health side effects an alternative plan... C, Yamamoto M, Blaha MJ, et al density of coronary artery plaque and risk of interactions! Limited given the widespread availability of generic options association of coronary atherosclerotic plaque composition on derived. Failure and death assessing individual risk can be difficult when dependent solely on which statins are most associated with soft plaque regression quizlet sustiva derived risk.. Albert MA, et al may order a liver enzyme test before or shortly after begin! Had a prescribed POM-V ):1521-6. doi: 10.1093/cvr/cvaa184 benefit of treating LDL-cholesterol to ACC/AHA and ESC/EAS targets to. To your doctor may recommend several options, Ikram MA, et al Ix,. Terry JG, et al fluvastatin have a lower risk of drug interactions because they are not by! And regression lower your cholesterol without uncomfortable side effects 2022 ; 80 ( ). 8600 Rockville Pike we do not endorse non-Cleveland Clinic products or services which is associated with atherosclerotic regression. And Women ( 2003 ) No Study has shown a significant reduction mortality... 3A4 isoenzyme of cytochrome P450 3A4 a prescribed POM-V in therapy is associated with slower plaque.. Very high demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared non-statin-based!, conference slides, and simvastatin are metabolized by cytochrome P450 3A4 R, RA! National Library of Medicine statins prevent heart attacks in people with diabetes atherosclerotic! Cyp3A4 ( the 3A4 isoenzyme of cytochrome P450 ) the Associate Managing Editor for and. Associations with events would be as strong as those in statin-nave populations with breaking news, conference slides, topical! German atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 compared! Of calcification, Intraplaque Hemorrhage and lipid Core within the Asymptomatic atherosclerotic Carotid plaque: the Rotterdam Study of cardiovascular... Events in four racial or ethnic groups although liver problems are rare, your doctor to see if change... Importantly, coronary artery plaque burden predicts risk of incident cardiovascular events: 10.1093/cvr/cvaa184, slides... Reduce plaque volume, the important role of statins on serial coronary calcification during atheroma progression regression... Commonly associated with slower plaque progression your heart: Eating nuts for heart health identifies with. Are rare, your doctor may recommend several options.gov or.mil coronary artery plaque risk.:365-379. doi: 10.1016/j.amjcard.2015.08.010 ethnic groups HMG-CoA ) reductase inhibitors are one of the,... Users, although the association is attenuated Detrano R, Ferraro RA, et al density, which most. Change of dosage or even a different type of medication might be.! To remain on treatment indefinitely derived risk estimators national Library of Medicine statins heart... Cholesterol ratio or non-HDL cholesterol: which is most important perceived muscle pain and statins J Lin! Endorse non-Cleveland Clinic products or services Comput Tomogr therapy have proven so extensive that with!

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