Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York.
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
JAMA Cardiol. 2021 Nov 1;6(11):1257-1266. doi: 10.1001/jamacardio.2021.3055.
The density of atherosclerotic plaque forms the basis for categorizing calcified and noncalcified morphology of plaques.
To assess whether alterations in plaque across a range of density measurements provide a more detailed understanding of atherosclerotic disease progression.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study enrolled 857 patients who underwent serial coronary computed tomography angiography 2 or more years apart and had quantitative measurements of coronary plaques throughout the entire coronary artery tree. The study was conducted from 2013 to 2016 at 13 sites in 7 countries.
The main outcome was progression of plaque composition of individual coronary plaques. Six plaque composition types were defined on a voxel-level basis according to the plaque attenuation (expressed in Hounsfield units [HU]): low attenuation (-30 to 75 HU), fibro-fatty (76-130 HU), fibrous (131-350 HU), low-density calcium (351-700 HU), high-density calcium (701-1000 HU), and 1K (>1000 HU). The progression rates of these 6 compositional plaque types were evaluated according to the interaction between statin use and baseline plaque volume, adjusted for risk factors and time interval between scans. Plaque progression was also examined based on baseline calcium density. Analysis was performed among lesions matched at baseline and follow-up. Data analyses were conducted from August 2019 through March 2020.
In total, 2458 coronary lesions in 857 patients (mean [SD] age, 62.1 [8.7] years; 540 [63.0%] men; 548 [63.9%] received statin therapy) were included. Untreated coronary lesions increased in volume over time for all 6 compositional types. Statin therapy was associated with volume decreases in low-attenuation plaque (β, -0.02; 95% CI, -0.03 to -0.01; P = .001) and fibro-fatty plaque (β, -0.03; 95% CI, -0.04 to -0.02; P < .001) and greater progression of high-density calcium plaque (β, 0.02; 95% CI, 0.01-0.03; P < .001) and 1K plaque (β, 0.02; 95% CI, 0.01-0.03; P < .001). When analyses were restricted to lesions without low-attenuation plaque or fibro-fatty plaque at baseline, statin therapy was not associated with a change in overall calcified plaque volume (β, -0.03; 95% CI, -0.08 to 0.02; P = .24) but was associated with a transformation toward more dense calcium. Interaction analysis between baseline plaque volume and calcium density showed that more dense coronary calcium was associated with less plaque progression.
The results suggest an association of statin use with greater rates of transformation of coronary atherosclerosis toward high-density calcium. A pattern of slower overall plaque progression was observed with increasing density. All findings support the concept of reduced atherosclerotic risk with increased densification of calcium.
动脉粥样硬化斑块的密度是对斑块进行钙化和非钙化形态分类的基础。
评估斑块密度的变化是否能更详细地了解动脉粥样硬化的进展情况。
设计、地点和参与者：这项队列研究纳入了 857 名患者，他们在 2 年或更长时间内接受了连续的冠状动脉计算机断层扫描血管造影检查，并对整个冠状动脉树的冠状动脉斑块进行了定量测量。该研究于 2013 年至 2016 年在 7 个国家的 13 个地点进行。
主要结局是个体冠状动脉斑块成分的进展。根据斑块衰减程度（以亨氏单位[HU]表示），将 6 种斑块成分类型定义为低衰减（-30 至 75 HU）、纤维脂肪（76-130 HU）、纤维（131-350 HU）、低密度钙（351-700 HU）、高密度钙（701-1000 HU）和 1K（>1000 HU）。根据他汀类药物使用与基线斑块体积之间的相互作用，调整了危险因素和扫描间隔，评估了这 6 种成分类型斑块的进展率。还根据基线钙密度检查了斑块的进展情况。在基线和随访匹配的病变中进行了分析。数据分析于 2019 年 8 月至 2020 年 3 月进行。
共纳入 857 名患者的 2458 个冠状动脉病变（平均[标准差]年龄 62.1[8.7]岁；540[63.0%]名男性；548[63.9%]接受他汀类药物治疗）。所有 6 种成分类型的未经治疗的冠状动脉病变体积随时间推移而增加。他汀类药物治疗与低衰减斑块（β，-0.02；95%置信区间，-0.03 至 -0.01；P = .001）和纤维脂肪斑块（β，-0.03；95%置信区间，-0.04 至 -0.02；P < .001）的体积减少以及高密度钙斑块（β，0.02；95%置信区间，0.01-0.03；P < .001）和 1K 斑块（β，0.02；95%置信区间，0.01-0.03；P < .001）的更大进展相关。当将分析仅限于基线时无低衰减斑块或纤维脂肪斑块的病变时，他汀类药物治疗与整体钙化斑块体积的变化无关（β，-0.03；95%置信区间，-0.08 至 0.02；P = .24），但与更密集的钙有关。基线斑块体积和钙密度之间的交互分析表明，更密集的冠状动脉钙与斑块进展减少有关。
结果表明，他汀类药物的使用与冠状动脉粥样硬化向高密度钙的转化率增加有关。观察到整体斑块进展速度较慢的模式，随着密度的增加而增加。所有发现都支持钙密集化与降低动脉粥样硬化风险的概念。
