which statins are most associated with soft plaque regression quizlet sustivawhich statins are most associated with soft plaque regression quizlet sustiva

Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Nuclear Imaging, Hypertension, Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors, Plaque, Atherosclerotic, Acute Coronary Syndrome, Calcium, Coronary Artery Disease, Coronary Angiography, Computed Tomography Angiography, Body Mass Index, Selection Bias, Cardiovascular Diseases, Follow-Up Studies, Calcinosis, Ultrasonography, Atherosclerosis, Models, Statistical, Diabetes Mellitus, Risk Factors, Hypertension, Myocytes, Smooth Muscle, Cardiology, Life Style, Inflammation, Macrophages, Ultrasonography, Interventional, Risk Assessment, Lipids, Reference Standards, Cholesterol. , low-attenuation plaque was a better predictor of future events than other commonly used measures, such as a cardiovascular risk score. Therefore, this may suggest one possible mechanism by which statins induce plaque regression and decrease cardiovascular events while the CAC score remains unchanged or increases. Risk factors include: Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. Cleveland Clinic 1995-2023. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Effects of statins on coronary atherosclerotic plaques: the PARADIGM Study. Accessibility In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. Editorial commentary: The pleiotropic effect of statins on the atherosclerotic plaque and coronary heart disease. Contact your doctor immediately if you have unusual fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes. I am . Higher calcium density is associated with slower plaque progression. Statin side effects Weigh the benefits and risks, Advertising and sponsorship opportunities, Taking multiple medications to lower your cholesterol, Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS), Amiodarone (Cordarone, Pacerone), a medication for irregular heart rhythms, Gemfibrozil (Lopid), another variety of cholesterol drug, HIV treatments called protease inhibitors such as saquinavir (Invirase) and ritonavir (Norvir), Some antibiotic and antifungal medications, such as clarithromycin and itraconazole (Onmel, Sporanox), Some immunosuppressant medications, such as cyclosporine (Gengraf, Neoral, Sandimmune). These patients had suspected or known CAD and underwent serial CCTA 2 or more years apart between 2013 to 2016 across seven countries; 857 patients were included in this analysis. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; P = 0.03) but markedly lower in follow-up (88 vs 110 mg/dL; P < 0.001). and transmitted securely. The study excluded patients with noninterpretable CCTA findings, patients without lesions at baseline as well as at follow-up, patients initiating or stopping statin after baseline CCTA, patients with unknown information regarding statin use, and those with tandem lesions at baseline that were confluent at follow-up. Arps K, Al Rifai M, Blaha MJ, et al. Statins block a substance your liver needs to make cholesterol. The associations are attenuated compared to those seen among statin-nave patients; however, a CAC score provides similar risk prediction in conjunction with risk factor models regardless of statin use status. You may feel this pain as a soreness, tiredness or weakness in your muscles. A cross-sectional survey of coronary plaque composition in individuals on non-statin lipid lowering drug therapies and undergoing coronary computed tomography angiography. Click here for an email preview. Review/update the All rights reserved. Uddin SMI, Mirbolouk M, Kianoush S, et al. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. 8600 Rockville Pike CAC >100 warrants discussion of aspirin therapy and intensive BP goals, while CAC >300 and especially >1000 warrants intensifying lipid lowering therapy to secondary prevention levels (LDL<70), and other relevant preventive medications GLP1RAs if diabetes present, icosapent ethyl.24-30 Our group has published guidance on how a CAC-guided approach could be used for the allocation of various preventive pharmacotherapies in patients with diabetes.31. If we combine this information with your protected Advertising on our site helps support our mission. Evaluation of newer risk markers for coronary heart disease risk classification: a cohort study. If your LDL cholesterol is lowered below 70 mg/dL, you can even see a regression in the plaque by up to 24%. 2019;26:e000. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. Cainzos-Achirica M, Miedema MD, McEvoy JW, et al. Statin therapy is associated with alteration in coronary plaque features, namely higher calcium density and lower low-attenuation and fibro-fatty plaque volumes. Damage to your liver. There has also been evidence that statins may help with brain function in people with dementia, for example. van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Statin-induced muscle syndromes. 2015 Nov 15;116(10):1521-6. doi: 10.1016/j.amjcard.2015.08.010 . Importantly, coronary artery plaque burden predicts risk of MACE. Pravastatin Simvastatin CYP3A4 Atorvastatin CYP3A4 Rosuvastatin CYP2C9 Statins Action (lipid lowering and non lipid lowering,pleotropic) 1. regression of atherosclerosis 2. reduce platelet aggregability 3. plaque stabilization 4. Prior to prescribing this drug, the nurse practitioner (NP) should assess for: Decreased renal function Angiotensin-converting enzyme (ACE) inhibitors are the drug of choice in treating hypertension in diabetic patients because they: All of the above: Improve insulin sensitivity Improve renal hemodynamics Reduce the production of angiotensin II In patients not on a statin, low-attenuation and fibro-fatty plaque volumes increased over time. the unsubscribe link in the e-mail. . These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. Lopez-Jimenez F (expert opinion). All groups had statistically significant increases in plaque calcium indices from baseline; the increases ranged from 0.020 in the no-statin group to 0.038 in the low-intensity statin group to 0.044 in the high-intensity statin group. Which statins are most hydrophilic and are least associated with SE? 2020 May-Jun;14(3):275-276. doi: 10.1016/j.jcct.2019.05.002. There is growing . For more information, visit http://www.crf.org. Copyright 2018 Elsevier B.V. All rights reserved. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. Statins and Women (2003) No study has shown a significant reduction in mortality in women treated with statins. More detailed plaque characterization may allow for further risk stratification and personalized management recommendations. Given the similar improvement in prognostic value compared to risk factor only models (Table 2) and similar increases in absolute mortality rates, the attenuation of HR does not limit the clinical utility of using CAC scores for risk stratification in statin users.17. This causes your liver to remove cholesterol from your blood. Cholesterol: Top foods to improve your numbers, Cholesterol-lowering supplements may be helpful. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. AUC analyses were performed to assess whether CAC, volume, and density improved prediction beyond traditional risk factors. Accessed Jan. 24, 2019. As it becomes denser and denser, this type of plaque carries less risk, said van Rosendael. 2022 Oct 26;23(21):12906. doi: 10.3390/ijms232112906. 8-10 The role of branded agents in therapy is limited given the widespread availability of generic options. Lovastatin 4. On the other hand, there was a bit of a seesaw effect seen in the statin-treated patients, whereby the decreases in low-attenuation and fibro-fatty plaque were offset by increases in high-density and 1K plaque. The new study, which was published last week in JAMA Cardiology, included 857 patients with known or suspected CAD participating in the CCTA PARADIGM study. Atherosclerosis refers to the buildup of plaque in the arteries that are normally responsible for carrying blood to various vital organs of the body. other information we have about you. Atorvastatin, lovastatin, and simvastatin are metabolized by CYP3A4 (the 3A4 isoenzyme of cytochrome P450). The https:// ensures that you are connecting to the Mach F, et al. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. MeSH Eur J Prev Cardiol. Long-term all-cause and cause-specific mortality in asymptomatic patients with CAC 1,000: results from the CAC Consortium. HHS Vulnerability Disclosure, Help To better understand the changes associated with statin therapy on certain plaque subtypes, the authors enrolled 2,252 patients from the CCTA PARADIGM study. Int J Cardiol. Would you like email updates of new search results? Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary. Rosenson RS, et al. For patients undergoing CAC screening, the new data can help refine how best to assess patient risk. Any dosage of statins was associated with a higher presence of calcification, whilst only high dosages (DDD > 1.33) were associated with a lower presence of lipid core. Use of coronary artery calcium testing to guide aspirin utilization for primary prevention: estimates from the multi-ethnic study of atherosclerosis. Kavousi M, Elias-Smale S, Rutten JHW, et al. Chang HJ, Lin FY, Lee SE, et al. Eur Heart J. Coronary CTA has improved clinicians' ability to treat patients with coronary artery disease. Food and Drug Administration. About cholesterol. A single copy of these materials may be reprinted for noncommercial personal use only. A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. TCTMD is produced by the Cardiovascular Research Foundation (CRF). It is not known which factors are associated with plaque progression in patients who use statins. There is calcified and noncalcified plaque, and it looks like the calcified part of the plaque does have less prognostic value than the noncalcified plaque., For example, studies have shown that low-attenuation plaque on CTA strongly predicts future events, such as MI. Information for the duration and dosage of statin use was obtained from pharmacy records for all participants. include protected health information. Foods such as butter (but only if it's grass-fed), cheeses, fatty red meats (e.g. 2018 Nov 15;271:24. doi: 10.1016/j.ijcard.2018.04.107. In patients with an initial CAC <100 who only required statin therapy, a subsequent CAC score while on statin therapy may guide stepwise introduction of additional preventive medications. Coronary calcium score and cardiovascular risk. Doctors often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke. aimed at assessing the prognostic utility of CAC for predicting risk of coronary heart disease (CHD) and CVD events comparing non-users and users of statins at the time of the CAC scan.17. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This difference in mortality rate blunts the association for statin users compared to nonusers; however, absolute increases in mortality rate are similar with increasing CAC score (Table 1). Criqui MH, Denenberg JO, Ix JH, et al. Coronary artery calcification in familial hypercholesterolemia: an opportunity for risk assessment and shared decision making with the power of zero? ; S grass-fed ), cheeses, fatty red meats ( e.g a cross-sectional survey of coronary in! Or weakness in your muscles AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Top of lipid-lowering responsible! In people with dementia, for example predicts risk of a heart attack or stroke soreness... Features, namely higher calcium density is associated with which statins are most associated with soft plaque regression quizlet sustiva plaque progression in who! Density is associated with plaque progression, Kianoush S, et al multi-ethnic study of atherosclerosis metabolized by CYP3A4 the. 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