Relationship Between Serum Inflammatory Marker Levels and the Dynamic Changes in Coronary Plaque Characteristics After Statin Therapy

Circ Cardiovasc Imaging. 2017 Jul;10(7):e005934. doi: 10.1161/CIRCIMAGING.116.005934.

Abstract

Background: The mechanism of statin for atheroma stabilization remains unclear. We aimed to assess the relationship between on-treatment changes in serum inflammatory biomarker levels and plaque composition in differed nonculprit coronary lesions.

Methods and results: The changes in serum biochemical values, and intravascular ultrasound data were evaluated in 218 patients with virtual histology (VH)-intravascular ultrasound-defined fibroatheroma-containing segments after 12-month rosuvastatin treatment. When stratifying patients into quartiles according to the change in high-sensitivity C-reactive protein (hsCRP), there was a significant positive linear relationship for the changes in %necrotic core (coefficient, 1.31; standard error, 0.54) and %dense calcium volumes (coefficient, 0.80; standard error, 0.27), but a negative linear relationship for the changes in %fibrous (coefficient, -0.94; standard error, 0.45) and %fibrofatty volumes (coefficient, -1.17; standard error, 0.56; all P<0.05). The decrease in hsCRP (-1.2±3.9 versus 0.5±3.4 mg/L; P=0.02) was greater in those without VH-defined thin-cap fibroatheroma (TCFA, defined as >30° of necrotic core abutting the lumen in 3 consecutive slices) than those with VH-TCFA at follow-up. Diabetes mellitus, a larger normalized total atheroma volume, and the presence of VH-TCFA at baseline predicted the presence of VH-TCFA at follow-up (odds ratio, 4.01, 1.18, and 9.21, respectively; all P<0.05), whereas the change in hsCRP showed a trend (odds ratio, 1.19; P=0.07). The change in low-density lipoprotein-cholesterol had no relationship with the changes in hsCRP or plaque compositions.

Conclusions: With 12-month rosuvastatin therapy, a greater hsCRP reduction (not low-density lipoprotein-cholesterol) was associated with a greater decrease in %necrotic core volume and the absence of VH-TCFA, indicating a link between the anti-inflammatory action of statin and plaque stabilization by reducing NC and reinforcing fibrous cap.

Clinical trial registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00997880.

Keywords: C-reactive protein; atherosclerosis; hydroxymethylglutaryl-CoA reductase inhibitors; inflammation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Biomarkers / blood
  • Chi-Square Distribution
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / drug therapy*
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / drug effects*
  • Double-Blind Method
  • Female
  • Fibrosis
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Inflammation Mediators / blood*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Necrosis
  • Odds Ratio
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors
  • Rosuvastatin Calcium / therapeutic use*
  • Seoul
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional
  • Vascular Calcification / blood
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / drug therapy

Substances

  • Anti-Inflammatory Agents
  • Biomarkers
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Inflammation Mediators
  • Rosuvastatin Calcium

Associated data

  • ClinicalTrials.gov/NCT00997880