A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography


Subhi J. Al'Aref, New York Presbyterian Hospital
Amanda Su, New York Presbyterian Hospital
Heidi Gransar, Cedars-Sinai Medical Center
Alexander R. van Rosendael, New York Presbyterian Hospital
Asim Rizvi, New York Presbyterian Hospital
Daniel S. Berman, Cedars-Sinai Medical Center
Tracy Q. Callister, Tennessee Heart and Vascular Institute
Augustin DeLago, Capitol Cardiology Associates
Martin Hadamitzky, Deutsches Herzzentrum München
Joerg Hausleiter, Ludwig-Maximilians-Universität München
Mouaz H. Al-Mallah, King Saud bin Abdulaziz University for Health Sciences
Matthew J. Budoff, The Lundquist Institute
Philipp A. Kaufmann, UniversitatsSpital Zurich
Gilbert L. Raff, William Beaumont Hospital
Kavitha Chinnaiyan, William Beaumont Hospital
Filippo Cademartiri, IRCCS Fondazione SDN
Erica Maffei
Todd C. Villines, Walter Reed National Military
Yong Jin Kim, Seoul National University Hospital
Jonathon Leipsic, The University of British Columbia
Gudrun Feuchtner, Medizinische Universitat Innsbruck
Gianluca Pontone, IRCCS Centro Cardiologico Monzino
Daniele Andreini, IRCCS Centro Cardiologico Monzino
Hugo Marques, Hospital da Luz
Pedro de Araújo Gonçalves, Hospital da Luz
Ronen Rubinshtein, Technion - Israel Institute of Technology
Stephan Achenbach, Friedrich-Alexander-Universität Erlangen-Nürnberg
Hyuk Jae Chang, Yonsei University College of Medicine
Benjamin J.W. Chow, University of Ottawa, Canada
Ricardo Cury, Baptist Cardiac and Vascular Institute
Yao Lu, New York Presbyterian Hospital
Jeroen J. Bax, Leiden University Medical Center - LUMC
Erica C. Jones, New York Presbyterian Hospital

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Journal of Cardiovascular Computed Tomography


© 2019 Introduction: Non-statin therapy (NST)is used as second-line treatment when statin monotherapy is inadequate or poorly tolerated. Objective: To determine the association of NST with plaque composition, alone or in combination with statins, in patients undergoing coronary computed tomography angiography (coronary CTA). Methods: From the multicenter CONFIRM registry, we analyzed individuals who underwent coronary CTA with known lipid-lowering therapy status and without prior coronary artery disease at baseline. We created a propensity score for being on NST, followed by stepwise multivariate linear regression, adjusting for the propensity score as well as risk factors, to determine the association between NST and the number of coronary artery segments with each plaque type (non-calcified (NCP), partially calcified (PCP)or calcified (CP))and segment stenosis score (SSS). Results: Of the 27,125 subjects in CONFIRM, 4,945 met the inclusion criteria; 371 (7.5%)took NST. At baseline, patients on NST had more prevalent risk factors and were more likely to be on concomitant cardiac medications. After multivariate and propensity score adjustment, NST was not associated with plaque composition: NCP (0.07 increase, 95% CI: −0.05, 0.20; p = 0.26), PCP (0.10 increase, 95% CI: −0.10, 0.31; p = 0.33), CP (0.18 increase, 95% CI: −0.10, 0.46; p = 0.21)or SSS (0.45 increase, 95% CI: −0.02,0.93; p = 0.06). The absence of an effect of NST on plaque type was not modified by statin use (p for interaction > 0.05 for all). Conclusion: In this cross-sectional study, non-statin therapy was not associated with differences in plaque composition as assessed by coronary CTA.





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