From the Guidelines
Statins do not have a significant effect on calcified plaque.
Rationale
- The evidence suggests that statins have anti-inflammatory and plaque stabilization effects, but these effects are more relevant to non-calcified plaques 1.
- Studies have shown that statins can delay coronary atherosclerosis progression and possibly induce plaque regression, but this is more related to non-calcified plaques 1.
- Specifically, in the context of calcified aortic stenosis (AS), large well-designed RCTs have failed to show a benefit of statin therapy in preventing disease progression or improving clinical outcomes 1.
- The 2014 and 2020 AHA/ACC guidelines for the management of patients with valvular heart disease do not recommend statin therapy for the prevention of hemodynamic progression of AS in patients with mild-to-moderate calcific valve disease 1.
- However, statins are still beneficial for patients with calcified plaques who are at high risk of cardiovascular events, as they can reduce the risk of major vascular events by 15% 1.
- The use of statins in these patients should be individualized, taking into account the potential benefits and risks, as well as patient preferences and comorbidities.
From the Research
Effect of Statins on Calcified Plaque
- Statin treatment is associated with a higher presence of calcification in carotid plaques, with longer duration of use strengthening this association 2.
- The use of statins is also associated with a lower presence of lipid core in carotid plaques, but only when used for 10 months or less 2.
- Statins disrupt the complex between Rac1 and its inhibitor RhoGDI, leading to increased active Rac1 in primary monocytes/macrophages, which can increase atherosclerotic calcification 3.
- Systemic inflammation, as measured by hs-CRP, plays a role in coronary calcification, with statin treatment over 2 years associated with a significant increase in coronary calcification in patients with higher systemic inflammation 4.
Association Between Statin Treatment and Plaque Composition
- In the non-statin group, CACS increase is positively associated with both non-calcified and calcified PV increase, while in the statin-taking group, CACS increase is positively associated with calcified PV change but negatively associated with non-calcified PV change 5.
- Statin therapy is associated with volume decreases in low-attenuation plaque and fibro-fatty plaque, and greater progression of high-density calcium plaque and 1K plaque 6.
- Statin use is associated with a transformation of coronary atherosclerosis toward high-density calcium, with more dense coronary calcium associated with less plaque progression 6.