Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study.
Authors
Singh, Parmanand
Emami, Hamed
Subramanian, Sharath
Maurovich-Horvat, Pal
Marincheva-Savcheva, Gergana
Medina, Hector M
Abdelbaky, Amr
Alon, Achilles
Shankar, Sudha S
Fayad, Zahi A
Hoffmann, Udo
Tawakol, Ahmed
Publication Date
2016-12Journal Title
Circulation. Cardiovascular imaging
ISSN
1941-9651
Publisher
American Heart Association
Volume
9
Language
English
Type
Article
This Version
AM
Physical Medium
Print
Metadata
Show full item recordCitation
Singh, P., Emami, H., Subramanian, S., Maurovich-Horvat, P., Marincheva-Savcheva, G., Medina, H. M., Abdelbaky, A., et al. (2016). Coronary Plaque Morphology and the Anti-Inflammatory Impact of Atorvastatin: A Multicenter 18F-Fluorodeoxyglucose Positron Emission Tomographic/Computed Tomographic Study.. Circulation. Cardiovascular imaging, 9 https://doi.org/10.17863/CAM.6637
Abstract
$\textbf{Background:}$ Non-obstructive coronary plaques manifesting higher-risk morphology (HRM) associate with an increased risk of adverse clinical cardiovascular events. We sought to test the hypothesis that statins have a greater anti-inflammatory effect within coronary plaques containing HRM.
$\textbf{Methods:}$ In this prospective multicenter study, 55 subjects with or at high risk for atherosclerosis underwent $^{18}$F-fluorodeoxyglucose-positron emission tomography/ computed tomography (FDG-PET/CT) imaging at baseline and after 12 weeks of treatment with atorvastatin. Coronary arterial inflammation (FDG uptake, expressed as target-to-background ratio [TBR]) was assessed in the left main coronary artery (LMCA). While blinded to the PET findings, contrast-enhanced CT angiography (CTA) was performed to characterize the presence of HRM (defined as non-calcified or partially-calcified plaques) in the LMCA.
$\textbf{Results:}$ Arterial inflammation (TBR) was higher in LMCA segments with- vs. without- HRM (mean ± SEM: 1.95±0.43 vs. 1.67±0.32, LMCA with- vs. without HRM, p=0.04). Moreover, atorvastatin treatment for 12 weeks reduced TBR more in LMCA segments with- vs without-HRM (12 week-baseline ΔTBR [95% CI]: -0.18 [-0.35, -0.004] vs. 0.09 [-0.06, 0.26], p=0.02). Furthermore, this relationship between coronary plaque morphology and change in LMCA inflammatory activity remained significant after adjusting for baseline LDL and statin dose ($\beta$=-0.27, p=0.038).
$\textbf{Conclusions:}$ In this first study to evaluate the impact of statins on coronary inflammation, we observed that the anti-inflammatory impact of statins is substantially greater within coronary plaques that contain higher-risk morphological features. These findings suggest an additional mechanism by which statins disproportionately benefit individuals with more advanced atherosclerotic disease.
Keywords
Coronary Vessels, Humans, Fluorodeoxyglucose F18, Anti-Inflammatory Agents, Inflammation Mediators, Radiopharmaceuticals, Coronary Angiography, Treatment Outcome, Severity of Illness Index, Risk Factors, Prospective Studies, Double-Blind Method, Predictive Value of Tests, Time Factors, Adult, Aged, Middle Aged, United States, Female, Male, Coronary Artery Disease, Plaque, Atherosclerotic, Vascular Calcification, Biomarkers, Atorvastatin Calcium, Computed Tomography Angiography, Positron Emission Tomography Computed Tomography
Sponsorship
National Heart, Lung, and Blood Institute of the National Institutes of Health (5T32 HL076136) and Marfan Foundation, National Institute for Health Research Cambridge Biomedical Research Centre, British Heart Foundation, Wellcome Trust
Funder references
British Heart Foundation (PG/09/083/27667)
British Heart Foundation (FS/12/29/29463)
Embargo Lift Date
2100-01-01
Identifiers
This record's DOI: https://doi.org/10.17863/CAM.6637
This record's URL: https://www.repository.cam.ac.uk/handle/1810/261449
Rights
Attribution 4.0 International, Attribution 4.0 International