What studies demonstrate plaque reduction with HMG-CoA reductase inhibitors (statins)?

From the Guidelines

Statins have been consistently shown to reduce plaque burden, with high-intensity statin therapy being the most effective approach, as demonstrated by the significant reduction in major cardiovascular events and improvement in lipoprotein levels in the TRACE RA study 1. The evidence from the TRACE RA study, which examined 3002 RA patients without CVD, found that atorvastatin 40 mg daily was associated with a 34% reduction in major cardiovascular events compared to placebo, with the event-rate reduction related to a decrease in LDL-C 1. Key findings from this study include:

• Significant improvement in lipoprotein levels
• 34% reduction in major cardiovascular events compared to placebo
• Safety profile similar to placebo
• Event-rate reduction related to decrease in LDL-C Additionally, post hoc analyses of RCTs from the general population and observational studies indicate that statins are efficient in primary and secondary cardiovascular prevention and reduce mortality in RA, with rosuvastatin treatment inducing carotid plaque regression in RA patients within 18 months 1. The benefits of statin therapy are further supported by a study of 49,227 RA patients, which found that protection against acute coronary syndrome increased with cumulative dose and length of statin treatment, with rosuvastatin-treated patients showing the most prominent benefits 1. Therefore, for optimal plaque reduction, high-intensity statin therapy, such as atorvastatin 40 mg daily or rosuvastatin 40 mg daily, should be maintained long-term, with target LDL levels below 1.8 mmol/L, as aimed for in the rosuvastatin treatment study 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Plaque Reduction with HMG-CoA Reductase Inhibitors (Statins)

• The use of statins is the preferred treatment strategy for the prevention of cardiovascular disease (CVD), and they have been shown to reduce the risk of major adverse cardiovascular events 2.
• Statins, such as atorvastatin and rosuvastatin, have pleiotropic effects that can improve endothelial integrity and reduce the risk of stroke 3, 4.
• Combination therapy with ezetimibe and statins has been shown to be effective in reducing low-density lipoprotein cholesterol (LDL-C) levels and preventing CVD events 2, 5, 6.
• The addition of ezetimibe to statin monotherapy has been shown to offer greater reduction in LDL-C levels compared to doubling the initial statin dose 6.
• Statins have been shown to prevent ischemic stroke, especially in patients with high cardiovascular risk and established atherosclerotic disease, and their use is not associated with an increased risk of intracranial bleeding in primary prevention studies 4.

Key Findings

• Ezetimibe plus statins probably reduces the risk of major adverse cardiovascular events compared with statins alone 2.
• The combination of rosuvastatin and ezetimibe has been shown to be effective in reducing LDL-C levels and preventing CVD events 5.
• Statins, such as rosuvastatin, can improve endothelial integrity and reduce the risk of stroke 3.
• The use of statins is associated with better survival and improved functional outcome when administered during the acute phase of stroke in statin-naive patients 4.