Atorvastatin 80 mg daily did not significantly reduce the rate of progression of coronary artery calcification compared to placebo (geometric mean difference 7%/year; 95% CI -3 to 18; p=0.18).
RCT (n=102)
Double-blind
minimisation technique
Does atorvastatin 80 mg daily reduce the rate of progression of coronary artery calcification in patients with calcific aortic stenosis and coronary artery calcification?
Intensive lipid-lowering with atorvastatin 80 mg daily does not significantly affect the rate of progression of coronary artery calcification compared to placebo, despite significant reductions in LDL-C and systemic inflammation.
Mean Difference: 7 (95% CI -3–18)
Absolute Event Rate: 26% vs 18%
p-value: p=0.18
OBJECTIVES: To evaluate the effect of intensive lipid-lowering treatment on coronary artery calcification in a substudy of a trial recruiting patients with calcific aortic stenosis. METHODS: In a double blind randomised controlled trial, 102 patients with calcific aortic stenosis and coronary artery calcification were randomly assigned by the minimisation technique to atorvastatin 80 mg daily or matched placebo. Coronary artery calcification was assessed annually by helical computed tomography. RESULTS: 48 patients were randomly assigned to atorvastatin and 54 to placebo with a median follow up of 24 months (interquartile range 24-30). Baseline characteristics and coronary artery calcium scores were similar in both groups. Atorvastatin reduced serum low density lipoprotein cholesterol (-53%, p 0.95 for both). The rate of change in coronary artery calcification was 26%/year (0.234 (SE 0.037) log arbitrary units (AU)/year; n = 39) in the atorvastatin group and 18%/year (0.167 (SE 0.034) log AU/year; n = 49) in the placebo group, with a geometric mean difference of 7%/year (95% confidence interval -3% to 18%, p = 0.18). Serum low density lipoprotein concentrations were not correlated with the rate of progression of coronary calcification (r = 0.05, p = 0.62). CONCLUSION: In contrast to previous observational studies, this randomised controlled trial has shown that, despite reducing systemic inflammation and halving serum low density lipoprotein cholesterol concentrations, statin treatment does not have a major effect on the rate of progression of coronary artery calcification.
Houslay et al. (Tue,) conducted a rct in calcific aortic stenosis and coronary artery calcification (n=102). atorvastatin vs. placebo was evaluated on rate of change in coronary artery calcification (geometric mean difference 7%/year, 95% CI -3 to 18, p=0.18). Atorvastatin 80 mg daily did not significantly reduce the rate of progression of coronary artery calcification compared to placebo (geometric mean difference 7%/year; 95% CI -3 to 18; p=0.18).