A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography.
J Cardiovasc Comput Tomogr. 2019 Mar - Apr;13(2):99-104. doi: 10.1016/j.jcct.2019.01.015. Epub 2019 Jan 29.
Al'Aref SJ1, Su A1, Gransar H2, van Rosendael AR1, Rizvi A3, Berman DS2, Callister TQ4, DeLago A5, Hadamitzky M6, Hausleiter J7, Al-Mallah MH8, Budoff MJ9, Kaufmann PA10, Raff GL11, Chinnaiyan K11, Cademartiri F12, Maffei E13, Villines TC14, Kim YJ15, Leipsic J16, Feuchtner G17, Pontone G18, Andreini D18, Marques H19, de Araújo Gonçalves P19, Rubinshtein R20, Achenbach S21, Chang HJ22, Chow BJW23, Cury R24, Lu Y25, Bax JJ26, Jones EC1, Peña JM1, Shaw LJ1, Min JK1, Lin FY27.
INTRODUCTION: Non-statin therapy (NST) is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated. OBJECTIVE: To determine the association of NST with plaque composition, alone or in combination with statins, in patients undergoing coronary computed tomography angiography (coronary CTA).
METHODS: From the multicenter CONFIRM registry, we analyzed individuals who underwent coronary CTA with known lipid-lowering therapy status and without prior coronary artery disease at baseline. We created a propensity score for being on NST, followed by stepwise multivariate linear regression, adjusting for the propensity score as well as risk factors, to determine the association between NST and the number of coronary artery segments with each plaque type (non-calcified (NCP), partially calcified (PCP) or calcified (CP)) and segment stenosis score (SSS).
RESULTS: Of the 27,125 subjects in CONFIRM, 4,945 met the inclusion criteria; 371 (7.5%) took NST. At baseline, patients on NST had more prevalent risk factors and were more likely to be on concomitant cardiac medications. After multivariate and propensity score adjustment, NST was not associated with plaque composition: NCP (0.07 increase, 95% CI: -0.05, 0.20; p = 0.26), PCP (0.10 increase, 95% CI: -0.10, 0.31; p = 0.33), CP (0.18 increase, 95% CI: -0.10, 0.46; p = 0.21) or SSS (0.45 increase, 95% CI: -0.02,0.93; p = 0.06). The absence of an effect of NST on plaque type was not modified by statin use (p for interaction > 0.05 for all).
CONCLUSION: In this cross-sectional study, non-statin therapy was not associated with differences in plaque composition as assessed by coronary CTA.
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