Munich, Germany - Lipid-lowering drugs may slow the progression of coronary artery calcification, new research suggests. Whether changes in coronary calcification seen on electron-beam computed tomography (EBCT) due to statin therapy actually translate into alterations in atherosclerotic plaque volume, composition, or vulnerability is still uncertain, the authors say.
Their study appears online in the August 6, 2002 rapid access issue of Circulation.
The popularity of fast CT scans for the detection and quantification of coronary artery calcification (CAC) is both booming and controversial, due in part to the aggressive marketing of the technology. Studies linking high calcium scores to presence of coronary disease and the risk of MI or stroke are proliferating, but skeptics of the modality point out that the added benefits of EBCT remain to be seen. In July 2000, an AHA/ACC consensus group concluded that the EBCT scan has proved "to have a predictive accuracy approximately equivalent to alternative methods for diagnosing coronary artery disease but has not been found to be superior to alternative noninvasive methods."
Tackling the topic from a new angle, Dr Stephan Achenbach (University of Erlangen-Nürnberg, Germany) and colleagues evaluated 66 patients with CAC detected by EBCT who had follow-up scans roughly 1 year after their first scan, during which time they took no lipid-lowering medications, then again after an additional 12 months on cerivastatin.
[Cerivastatin (Baycol®/Lipobay® - Bayer) was pulled from markets around the globe following reports of fatal rhabdomyolysis. In Germany, Achenbach et al's study was terminated prematurely and with fewer patients than initially intended due to the withdrawal of the drug.]
They found that the mean volume of CAC increased from 155 mm3 at baseline to 201 mm3 after 1 year on no medication. By contrast, during the subsequent year when the study subjects were taking cerivastatin, mean volume of CAC increased only marginally, to 203 mm3. During this same period, LDL and total cholesterol levels decreased significantly from pretreatment levels.
Strikingly, in 32 patients whose LDL levels fell below 100 mg/dL during the year on cerivastatin, CAC did not progress at all.
| Measure |
Baseline |
12 months, untreated |
12 months, cerivastatin |
p value |
| 155 |
201 |
203 |
0.01* |
|
| 164+30 |
107+21 |
<0.0001 |
||
| 51+12 |
52+12 |
0.3 |
||
| 184+106 |
152+68 |
0.004 |
||
| 244+32 |
188+28 |
<0.0001 |
"Progression of coronary calcification was significantly less pronounced during treatment with cerivastatin compared with the period before treatment was initiated," Achenbach and colleagues write.
They conclude that changes in CAC likely point to "activity" of the atherosclerotic process and that quantification of CAC using fast CT techniques may be a promising tool for assessing disease progression. Nonetheless, "the relationship between changes in the amount of CAC and changes in overall plaque burden and plaque vulnerability deserves additional investigation.
|
Heartwire from Medscape © 2002
Cite this: Statin slows progression of coronary artery calcification: EBCT findings - Medscape - Aug 05, 2002.
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