At the KAHN CENTER, we follow the guidelines suggested by the SHAPE society nearly 20 years ago: cholesterol lowering medications like statins benefit those with coronary artery disease (CAD) but not those without. Those recommenations, based on calcium scoring (CACS) and carotid ultrasound (CIMT), were endorse by the American Heart Association in 2019.
CACS is still a very useful screening tool but the more advanced coronary CT angiogram (CCTA) is being used more and more to visualize both "hard" and "soft" plaque.
A
new study used CCTA and examined the presence or absence of CAD on outcomes in terms of statin Rx medications.
STUDY
The study aimed to evaluate whether statins decrease major adverse cardiac events (MACE) among patients evaluated for CAD according to severity, vulnerability and extent categorized by CCTA.
The authors analyzed consecutive patients who were referred for coronary CTA at a tertiary center for the assessment of chronic coronary syndrome. The primary endpoint was MACE defined as a composite of all-cause mortality, acute myocardial infarction, or revascularization for unstable angina.
Statin use was defined as annualized days on statin therapy (days on statin based on redeemed prescriptions, divided by follow-up time), and analyzed for each 10% increase in statin use over the follow-up period.
RESULTS
Overall, 11,026 individuals (mean age: 59 years, 55 % male) were analyzed who underwent CCTA between January 1, 2013, and December 31, 2020.
A 10% increase in statin use was associated with lower risk for MACE the stratified Cox-regression model in patients with CAD but not in patients without CAD.
In the total population, a 10% increase in statin use decreased the risk for MACE in the presence of obstructive CAD, high-risk plaque, and a CACSof ≥400.
CONCLUSIONS
Patients without CAD have no benefit from statin therapy regarding MACE. Just like the proposal by the SHAPE society nearly 20 years ago using CACS, the more advanced CCTA may play a pivotal role in optimizing statin allocation for personalized treatment decisions to prevent MACE.
At the KAHN CENTER, we will stop statin Rx medications of there is little or no CAD on CACS or CCTA studies. This new study is an important addition to the personalized approach to CAD therapy.
