Key result
Statin therapy improves carotid plaque stability in a dose-dependent manner, evidenced by favorable changes in imaging indices and inflammatory biomarkers, beyond mere lipid-lowering effects.
Why the study?
To summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers, propose an alternative implementation approach, and assess perioperative and aggressive versus conventional statin therapy.
Does statin therapy improve imaging and biomarker indices of carotid plaque vulnerability in patients with carotid atherosclerosis?
Does statin therapy improve imaging and biomarker indices of carotid plaque vulnerability in patients with carotid atherosclerosis?
Answers are grounded in this paper and cite their sources.
Statin therapy provides dose-dependent stabilization of carotid plaques beyond lipid-lowering, suggesting that imaging and biomarkers could be used to guide personalized treatment targets.
Novel imaging techniques and biomarkers have emerged as surrogate markers of carotid plaque vulnerability. In parallel, statin administration in patients with established carotid atherosclerosis not requiring revascularization has reduced the number of consequent cerebrovascular events. This reduction is not only attributed to the lipid-lowering properties of statins but also to their pleiotropic actions. The present literature review aimed to summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers and propose an alternative approach to their implementation. Moreover, we assessed the perioperative use of statins in patients undergoing carotid revascularization and the impact of aggressive vs. conventional statin therapy. Recent studies using: (1) ultrasound indices of plaque echogenicity; (2) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans for plaque inflammation assessment; or (3)magnetic resonance imaging (MRI) scans quantifying intraplaque hemorrhage, and lipid-rich necrotic core (LRNC) have shown quite promising results in evaluation of carotid plaque vulnerability. Based on those imaging modalities, a growing number of studies have demonstrated a very modest carotid plaque regression due to/induced by statins, while their stabilizing impact is disproportionally higher. Other studies assaying several biomarkers (e.g. inflammation, etc.) have confirmed a statin-induced carotid plaque stabilization. All the aforementioned benefits followed a dose-dependent pattern of statins, on top of the low-density lipoprotein cholesterol (LDL-C) target in current guidelines. In the case of symptomatic patients with carotid atherosclerosis suitable for revascularization, robust evidence implicates a significant statin-related reduction of perioperative cardiovascular risk only in patients undergoing endarterectomy.
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Kadoglou et al. (2022) conducted a review in Carotid atherosclerosis. Statin therapy vs. Conventional therapy or placebo (across various studies) was evaluated on Carotid plaque vulnerability (imaging indices and biomarkers). Statin therapy improves carotid plaque stability in a dose-dependent manner, evidenced by favorable changes in imaging indices and inflammatory biomarkers, beyond mere lipid-lowering effects.
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