Abstract Background Use of statins has reduced the prevalence of major cardiovascular events in patients with coronary artery disease (CAD). How statins contribute to the stabilization of plaques through increased calcification in non-obstructive CAD is less studied. Purpose To explore the association between statins and plaque subtypes by coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD). Methods This study included 1178 patients with non-obstructive CAD by CCTA from the Norwegian Registry of Invasive Cardiology. All patients underwent CCTA with quantitative plaque measurements. Coronary plaque subtypes were automatically subclassified into calcified (350 Hounsfield Units HU), noncalcified fibrous (131-350 HU) and low-attenuation plaques (130 to -75 HU). In logistic regression analysis, a high calcified plaque burden was defined as above median calcified plaque burden for the study population. Results Statin use was found in 39% of patients, and the prevalence of statin use was similar between sexes. Patients on statin treatment were older, and had a higher body mass index, coronary artery calcium score, and prevalence of hypertension and diabetes (all p0.05). Patients on statin treatment had higher proportions of calcified plaques, and lower proportions of noncalcified fibrous plaques compared to patients without statin treatment (Fig. 1). There was no difference in total or low-attenuation plaque burden between groups (all p0.05). After adjusting for age, sex, diabetes, hypertension, obesity, and smoking, statin treatment was independently associated with a high calcified plaque burden in multivariate logistic regression analysis (OR 1.4, 95% CI 1.1-1.9, p=0.015). Conclusions In non-obstructive CAD, statin use was independently associated with an increased calcified plaque burden by CCTA. Our results confirm that statin treatment could improve plaque stabilization through increased plaque calcification also in non-obstructive CAD. Whether quantitative assessment of plaque subtypes by CCTA could enhance risk assessment in non-obstructive CAD should be further explored. Fig. 1. Compositional plaque burden according to groups with and without statin treatment
Hondros et al. (Sat,) studied this question.