From the The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
Cardiol Rev. 2023;31(6):293-298. doi: 10.1097/CRD.0000000000000438. Epub 2022 Jan 6.
Lipid-lowering therapy with statins is well recognized as an effective therapy in reducing adverse cardiovascular events. However, the relationship between statin therapy and progression of coronary artery calcification (CAC) is unclear. A few of studies suggested that statins fail to slow and even accelerate progression of CAC; meanwhile, some researchers demonstrate opposite results. With the purpose of seeking out the effect of statin therapy on CAC, we summarized the existing evidence on statins and undertook meta-analyses of clinical trials assessing the effect of statin therapy on CAC. Fourteen trials were identified suitable for inclusion in the analysis of the effect of statin treatment on CAC, of which 11 were randomized controlled trails, 1 was case-control study, 1 was cross-sectional study, and 1 was observational study. In the meta-analysis of CAC progression, statin therapy seemed to accelerate the progression of CAC. Meanwhile, the analysis revealed a significant correlation between statin treatment and lower risk of cardiovascular events. In conclusion, meta-analyses of the available trials have shown a significant reduction of risk of cardiovascular events. In contrast, statins accelerated CAC. This suggests that statin-mediated atheroma calcification may enhance plaque stability and reduce the risk of plaque rupture.
降脂治疗中的他汀类药物被广泛认为是降低不良心血管事件的有效治疗方法。然而，他汀类药物治疗与冠状动脉钙化（CAC）进展之间的关系尚不清楚。一些研究表明，他汀类药物未能减缓甚至加速 CAC 的进展；同时，一些研究人员得出了相反的结果。为了寻找他汀类药物治疗 CAC 的效果，我们总结了现有的他汀类药物证据，并对评估他汀类药物治疗 CAC 效果的临床试验进行了荟萃分析。确定了 14 项适合纳入 CAC 治疗效果分析的试验，其中 11 项为随机对照试验，1 项为病例对照研究，1 项为横断面研究，1 项为观察性研究。在 CAC 进展的荟萃分析中，他汀类药物治疗似乎加速了 CAC 的进展。同时，分析显示他汀类药物治疗与心血管事件风险降低之间存在显著相关性。总之，现有试验的荟萃分析表明，心血管事件风险显著降低。相比之下，他汀类药物加速了 CAC 的进展。这表明他汀类药物介导的动脉粥样硬化钙化可能增强斑块稳定性，降低斑块破裂的风险。
