Abstract 16602: Atorvastatin Alters Coronary Plaque Composition and Distribution of Plaque Changes on CTA: Plaque-based Analysis in a Randomized Controlled Trial of Atorvastatin in HIV
Introduction: Coronary CT angiography (CTA) demonstrates reduction in total non-calcified coronary plaque volume in HIV with statin treatment. However changes in coronary plaque composition as well as heterogeneity of individual plaque changes within a patient have not been described.
Hypothesis: Atorvastatin decreases the fat/fibrotic components and increases calcified component of coronary plaque while reducing intra-patient variance of plaque changes.
Methods: Forty patients with subclinical coronary atherosclerosis, LDL <130 mg/dL, and treated HIV were randomized to placebo vs. atorvastatin 40 mg QD. Coronary CTA at baseline and 12 months assessed change in coronary plaque composition and distribution on a per plaque basis. The volume of fatty, fibrotic, and calcified plaque was quantified by fixed density thresholds (<39 / 40-129 / >130 HU).
Results: In 20 patients on placebo with 37 plaques and 17 on statin with 33 plaques, statin led to a relative decrease in the fat / fibrotic component with trend towards lesser increase in the calcified component. Median change of fat / fibrotic / calcified volume was +24.5% / +15.9% / +28.7% with placebo and -31.6%/ -7.4%/ +6.7% with statin (p for difference of differences 0.006 / 0.026 / 0.076). Statin reduced the relative variability of volume changes 76% compared to placebo (Fig. 1).
Conclusions: Compared to placebo, statin reduces the fatty and fibrotic component of coronary plaque. The calcified component increased in both groups, with a trend towards a greater increase with placebo. The natural progression of individual plaques is variable within a given patient; statin reduces this intra-patient variability.
Author Disclosures: B. Foldyna: None. J. Lo: None. S. Grinspoon: Consultant/Advisory Board; Modest; Navidea, Theratechnologies, Bristol Meyers Squibb, Merck, Gilead. U. Hoffmann: Research Grant; Significant; HeartFlow, Siemens Healthcare. Consultant/Advisory Board; Significant; HeartFlow. M. Lu: None.
- © 2016 by American Heart Association, Inc.