Abstract 10446: Accelerated Progression of Coronary Atherosclerosis in Hyporesponders to Statin Therapy
Background: Lowering LDL-C with statins has been demonstrated to slow plaque progression and reduce cardiovascular events. The impact in patients with minimal LDL-C lowering has not been investigated.
Methods: 647 patients with angiographic coronary artery disease who were commenced on statin therapy underwent serial imaging with intravascular ultrasound. Responders were defined as a percentage reduction of LDL-C of >15%. Clinical characteristics and disease progression were compared in responders (n=517) and hyporesponders (n=130) to statin therapy.
Results: 20% of patients demonstrated minimal changes in LDL-C despite use of statin therapy. These patients were less likely to be treated with rosuvastatin (10.8 v. 46.8%, p<0.001) and high-dose statin therapy (17.1 v. 69.0%, p<0.001). Hypo-responders were also younger (56 v. 58 years, p=0.01), more likely to be male (79 v. 67%, p=0.005), obese (BMI 31.5±6.1 v. 30.3±5.9 kg/m2, p=0.03) and have a history of atrial fibrillation (10 v. 3%, p=0.006) and less likely to have a history of dyslipidemia (50 v. 67%, p=0.001) and percutaneous coronary intervention (32 v. 49%, p=0.001). Baseline levels of systolic blood pressure (128±16 v. 132±18 mmHg, p=0.01) and LDL-C (99±27 v. 135±31 mg/dL, p<0.001) were lower in statin hyporesponders. After adjusting for baseline measures of plaque burden and LDL-C, greater progression of percent atheroma volume (+1.22±0.49 v. +0.09±0.42%, p=0.004) was observed in hyporesponders.
Conclusions: A substantial proportion of patients with coronary artery disease fail to achieve effective reductions in LDL-C despite prescription of statin therapy. Greater progression of atherosclerosis is observed in these patients. These findings highlight the need to emphasize compliance with statins and use of higher doses to reduce cardiovascular risk.
- © 2011 by American Heart Association, Inc.