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Abstract Background Coronary computed tomography (CCT) has validated the use of perivascular fat attenuation index (PVAT-FAI) as a credible indicator of coronary inflammation and plays a crucial role in coronary artery disease (CAD), particularly concerning plaque vulnerability and progression. Various investigations have delved into the potential benefits of statins in mitigating the hazard of plaque rupture and ensuing cardiovascular episodes. The impact of statin therapy on PVAT-FAI, however, remains yet to be distinctly illustrated. Purpose We aimed to evaluate the long-term effects of high-dose statins on PVAT-FAI changes at the site of coronary lesions and to examine changes in plaque distribution and lipid profile modifications during follow-up visits. Methods Our prospective observational study included patients with typical chest pain, a low-to-intermediate likelihood of CAD, and documented atheromatous plaque through CCT. Following ESC guidelines, they received high-dose statin therapy and underwent serial CCT using a 128-slice scanner over 1 to 3 years. We utilized advanced features of the CaRi-Heart® and syngo.via Frontier® systems to assess coronary plaques and measure changes in PVAT attenuation. Results 52 patients (mean age 60.43 ± 9.21, 65.38% males). Changes in plaque morphology were investigated, revealing significant alterations. Notably, in mixed plaques, calcified portions increased (from 53.92 ± 31.29 mm³ to 87.42 ± 43.48 mm³, p 0.0001), while non-calcified plaque volume (NCPV) decreased (from 180.5 ± 66.81 mm³ to 155.4 ± 59.51 mm³, p = 0.0209). PVAT attenuation generally decreased after one year and remained low, indicating reduced inflammation in the following arteries: LAD (15.93 ± 9.22 vs. 12.03 ± 6.27, p = 0.0142), LCX (14.78 ± 7.35 vs. 12.15 ± 7.51, p = 0.0513), and RCA (19.60 ± 8.99 vs. 16.73 ± 9.17, p = 0.1249). The CaRi-Heart® risk also decreased significantly (from 33.20 ± 22.07 to 20.65 ± 16.14, p = 0.0041). Linear regression analysis demonstrated a correlation between increased PVAT attenuation and higher volumes of NCPV (p 0.0001, r = 0.3032) and lipid-rich plaque volume (p 0.0001, r = 0.3281). Conclusion Our study provides evidence that high-dose statin therapy significantly reduces CAD risk factors, inflammation, and plaque vulnerability, as evidenced by the notable decrease in PVAT attenuation, a critical indicator of plaque progression. The effect of statins on FAI - Score
Matyas et al. (Sat,) studied this question.