CT Angio reveals statins benefit even in non-obstructive atherosclerosis : CONFIRM study

Statins may be beneficial even in patients with lower degrees of subclinical atherosclerosis as detected by Coronary computed tomographic angiography (CCTA).

A new study published in the journal PLOS One has reported that statin therapy is associated with decreased risk of cardiac events in the presence of increasing atherosclerosis, with no particular threshold of disease burden.

Coronary artery calcium (CAC) scoring is used to predict the risk of major adverse cardiac events (MACE), and current societal guidelines recommend a threshold of ≥300 Agatston units for consideration of statin treatment. In patients with non-obstructive coronary artery disease (CAD) by CCTA, the comparative effect of statin therapy on MACE for individuals with evident CAC or atherosclerotic plaque by Coronary computed tomographic angiography (CCTA) is unknown.

James Min and associates conducted a study to evaluate the relationship between statin therapy, mortality, and subclinical atherosclerosis.

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The study known as CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter) included patients with normal or non-obstructive plaque (<50% diameter stenosis) for whom data on baseline statin use was available. 8,016 patients were followed for a median of 2.5 years with analysis of all-cause mortality and major adverse cardiac events (MACE) including all-cause mortality, myocardial infarction, unstable angina, target vessel revascularization, and coronary artery disease-related hospitalization.

The investigators found that statin therapy reduced the risk of mortality and other adverse events at nearly all levels of calcium and atherosclerosis scores measured on CCTA scans even for patients with very low CT coronary artery calcium (CAC)and segment involvement scores (SIS). SIS measures the extent of atherosclerosis in patients based on the number of coronary artery segments (up to 16) found to contain plaques on CCTA scans.

Moreover, the patients' risk of adverse cardiac events progressively increased as the CCTA calcium and atherosclerosis scores increased, and statins helped attenuate this risk at most scores regardless of plaque severity.

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"In this prospective multinational cohort study of individuals undergoing CCTA, we identified a stepwise increased risk of all-cause mortality for individuals with increased atherosclerotic burden despite the absence of anatomically obstructive CAD, "write the authors.

The study concluded that the baseline use of statins was associated with mitigation of increased mortality risk despite the presence or burden of non-obstructive atherosclerosis and the findings support the notion that statins may be beneficial in even patients with lower degrees of subclinical atherosclerosis as detected by CCTA.

For full information log on to https://doi.org/10.1371/journal.pone.0207194