Weichsel Loris, André Florian, Renker Matthias, Breitbart Philipp, Overhoff Daniel, Beer Meinrad, Giesen Alexander, Vattay Borbála, Buss Sebastian, Marwan Mohamed, Schlett Christopher L, Giannopoulos Andreas A, Kelle Sebastian, Frey Norbert, Korosoglou Grigorios
Department of Cardiology & Vascular Medicine & Pneumology, GRN Hospital Weinheim, Roentgenstrasse 1, 69469, Weinheim, Germany.
Cardiac Imaging Center Weinheim, Hector Foundations, Weinheim, Germany.
Clin Res Cardiol. 2024 Jul 30. doi: 10.1007/s00392-024-02502-6.
To evaluate the effects of lipid-lowering medications of different intensities on total, calcified, and non-calcified plaque volumes in patients undergoing serial cardiac computed tomography angiography (CCTA).
Individuals with chronic coronary syndromes from 11 centers were included in a retrospective registry. Total, calcified, and non-calcified plaque volumes were quantified and the relative difference in plaque volumes between baseline and follow-up CCTA was calculated. The intensity of lipid-lowering treatment was designated as low, moderate, or high, based on current recommendations.
Of 216 patients (mean age 63.1 ± 9.7 years), undergoing serial CCTA (median timespan = 824.5 [IQR = 463.0-1323.0] days), 89 (41.2%) received no or low-intensity lipid-lowering medications, and 80 (37.0%) and 47 (21.8%) moderate- and high-intensity lipid-lowering agents, respectively. Progression of total and non-calcified plaque was attenuated in patients on moderate-/high- versus those on no/low-intensity treatment and arrested in patients treated with high-intensity statins or PCSK9 inhibitors (p < 0.001). Halted increase of non-calcified plaque was associated with LDL-cholesterol reduction (p < 0.001), whereas calcified plaque mass and Agatston score increased irrespective of the lipid-lowering treatment (p = NS). The intensity of lipid-lowering therapy robustly predicted attenuation of non-calcified plaque progression as a function of the time duration between the two CCTA scans, and this was independent of age and cardiovascular risk factors (HR = 3.83, 95% CI = 1.81-8.05, p < 0.001).
The LOCATE multi-center observational study shows that progression of non-calcified plaques, which have been previously described as precursors of acute coronary syndromes, can be attenuated with moderate-intensity, and arrested with high-intensity lipid-lowering therapy.
DRKS00031954.
评估不同强度降脂药物对接受系列心脏计算机断层扫描血管造影（CCTA）患者的总斑块体积、钙化斑块体积和非钙化斑块体积的影响。
来自11个中心的慢性冠状动脉综合征患者被纳入一项回顾性登记研究。对总斑块体积、钙化斑块体积和非钙化斑块体积进行量化，并计算基线和随访CCTA之间斑块体积的相对差异。根据当前建议，将降脂治疗强度分为低、中或高。
在216例接受系列CCTA（中位时间跨度=824.5[四分位间距=463.0-1323.0]天）的患者中，89例（41.2%）未接受或接受低强度降脂药物治疗，80例（37.0%）接受中等强度降脂药物治疗，47例（21.8%）接受高强度降脂药物治疗。与未接受/低强度治疗的患者相比，接受中等强度/高强度治疗的患者总斑块体积和非钙化斑块体积的进展有所减缓，而接受高强度他汀类药物或前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂治疗的患者斑块体积进展停滞（p<0.001）。非钙化斑块增加的停滞与低密度脂蛋白胆固醇降低有关（p<0.001），而钙化斑块质量和阿加斯顿评分无论降脂治疗如何均增加（p=无显著性差异）。降脂治疗强度有力地预测了非钙化斑块进展的减缓，这是两次CCTA扫描之间时间持续的函数，且独立于年龄和心血管危险因素（风险比=3.83，95%置信区间=1.81-8.05，p<0.001）。
LOCATE多中心观察性研究表明，先前被描述为急性冠状动脉综合征先兆的非钙化斑块进展可通过中等强度降脂治疗减缓，并通过高强度降脂治疗停滞。
DRKS00031954。
