In an original investigation published in JAMA Cardiology on August 18, 2021, a team led by Alexander van Rosendael found that statin therapy not only decreased some plaques but was associated with “greater rates of transformation of coronary atherosclerosis towards high-density calcium, supporting the concept of reduced atherosclerotic risk with increased densification of calcium.”

The study team looked at six plaque composition types “defined on a voxel-level basis according to the plaque attenuation (expressed in Hounsfield units [HU]): low attenuation (−30 to 75 HU), fibro-fatty (76-130 HU), fibrous (131-350 HU), low-density calcium (351-700 HU), high-density calcium (701-1000 HU), and 1K (>1000 HU).” They found that statin therapy was associated with volume decreases in low-volume and fibro-fatty plaque, and with greater progression of high-density calcium and 1K plaque. “When analyses were restricted to lesions without low-attenuation plaque or fibro-fatty plaque at baseline, statin therapy was not associated with a change in overall calcified plaque volume (β, −0.03; 95% CI, −0.08 to 0.02; P = .24) but was associated with a transformation toward more dense calcium. Interaction analysis between baseline plaque volume and calcium density showed that more dense coronary calcium was associated with less plaque progression,” wrote the authors.

“The results suggest an association of statin use with greater rates of transformation of coronary atherosclerosis toward high-density calcium. A pattern of slower overall plaque progression was observed with increasing density. All findings support the concept of reduced atherosclerotic risk with increased densification of calcium,” concluded van Rosendael, et. al.

Source:

van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Association of Statin Treatment With Progression of Coronary Atherosclerotic Plaque Composition. JAMA Cardiol. Published online August 18, 2021. doi:10.1001/jamacardio.2021.3055 Abstract available at https://jamanetwork.com/journals/jamacardiology/article-abstract/2783117  Accessed August 23, 2021.