Progressive coronary calcification despite intensive lipid-lowering therapy: a randomised controlled trial

Emma Houslay ¹, Sarah Joanna Cowell ¹, Robin Prescott ¹, John Reid ², Judith Burton ², David B Northridge ¹, Nicholas A Boon ¹ and David E Newby ^1*

¹ University of Edinburgh, United Kingdom
² Borders General Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: d.e.newby{at}ed.ac.uk.

Accepted 17 January 2006

Abstract

ObjectivesObservational studies have suggested that statin therapy may induce regression of coronary artery calcification. In a substudy of a trial recruiting patients with calcific aortic stenosis, we evaluated the effect of intensive lipid-lowering therapy on coronary artery calcification.

Methods In a double blind randomised controlled trial, 102 patients with calcific aortic stenosis and coronary artery calcification were randomised using the minimisation technique to atorvastatin 80 mg daily or matched placebo. Coronary artery calcification was assessed annually by helical computed tomography.

Results Forty-eight patients were randomised to atorvastatin and 54 to placebo with a median follow-up of 24 months (interquartile range, 24-30). Baseline characteristics and coronary artery calcium scores were similar in both groups. Atorvastatin therapy reduced serum low-density lipoprotein cholesterol (-53%; P<0.001) and C-reactive protein (-49%; P<0.001) concentrations whilst there was no change with placebo (- 7% and +17%; P>0.95 for both). The rate of change in coronary artery calcification was 26%/yr (0.234 (SE 0.037) logAU/yr; n=39) in the atorvastatin group and 18%/yr (0.167 (SE 0.034) log AU/yr; n=49) in the placebo group: geometric mean difference of +7%/yr (95% confidence intervals -3% to +18%; P=0.18). There was no correlation between serum low-density lipoprotein concentrations and the rate of progression of coronary calcification (r=0.05, P=0.62).

Conclusion In contrast to previous observational studies, this randomised controlled trial has shown that, despite reducing systemic inflammation and halving serum low-density lipoprotein cholesterol concentrations, statin therapy does not have a major effect on the rate of progression of coronary artery calcification.

Keywords: tomography, x-ray computed, calcification, coronary arteries, lipids

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Lehman, S. J., Schlett, C. L., Bamberg, F., Lee, H., Donnelly, P., Shturman, L., Kriegel, M. F., Brady, T. J., Hoffmann, U. (2009). Assessment of Coronary Plaque Progression in Coronary Computed Tomography Angiography Using a Semiquantitative Score. J Am Coll Cardiol Img 2: 1262-1270 [Abstract] [Full Text]  
• Monzack, E. L., Gu, X., Masters, K. S. (2009). Efficacy of Simvastatin Treatment of Valvular Interstitial Cells Varies With the Extracellular Environment. Arterioscler. Thromb. Vasc. Bio. 29: 246-253 [Abstract] [Full Text]  
• McCullough, P. A., Agrawal, V., Danielewicz, E., Abela, G. S. (2008). Accelerated Atherosclerotic Calcification and Monckeberg's Sclerosis: A Continuum of Advanced Vascular Pathology in Chronic Kidney Disease. CJASN 3: 1585-1598 [Abstract] [Full Text]  
• How, P. P., Mason, D. L., Lau, A. H. (2008). Current Approaches in the Treatment of Chronic Kidney Disease Mineral and Bone Disorder. Journal of Pharmacy Practice 21: 196-213 [Abstract]  
• Awan, Z., Alrasadi, K., Francis, G.A., Hegele, R.A., McPherson, R., Frohlich, J., Valenti, D., de Varennes, B., Marcil, M., Gagne, C., Genest, J., Couture, P. (2008). Vascular Calcifications in Homozygote Familial Hypercholesterolemia. Arterioscler. Thromb. Vasc. Bio. 28: 777-785 [Abstract] [Full Text]  
• Anand, D. V., Lim, E., Darko, D., Bassett, P., Hopkins, D., Lipkin, D., Corder, R., Lahiri, A. (2007). Determinants of Progression of Coronary Artery Calcification in Type 2 Diabetes: Role of Glycemic Control and Inflammatory/Vascular Calcification Markers. J Am Coll Cardiol 50: 2218-2225 [Abstract] [Full Text]  
• Erbel, R., Mohlenkamp, S., Kerkhoff, G., Budde, T., Schmermund, A. (2007). Non-invasive screening for coronary artery disease: calcium scoring. Heart 93: 1620-1629 [Full Text]  
• Cassidy-Bushrow, A. E., Bielak, L. F., Sheedy, P. F. II, Turner, S. T., Kullo, I. J., Lin, X., Peyser, P. A. (2007). Coronary Artery Calcification Progression Is Heritable. Circulation 116: 25-31 [Abstract] [Full Text]  
• Schurgers, L. J., Spronk, H. M. H., Soute, B. A. M., Schiffers, P. M., DeMey, J. G. R., Vermeer, C. (2007). Regression of warfarin-induced medial elastocalcinosis by high intake of vitamin K in rats. Blood 109: 2823-2831 [Abstract] [Full Text]  
• Waxman, S., Ishibashi, F., Muller, J. E. (2006). Detection and Treatment of Vulnerable Plaques and Vulnerable Patients: Novel Approaches to Prevention of Coronary Events. Circulation 114: 2390-2411 [Full Text]  
• Cademartiri, F (2006). Is calcium the key for the assessment of progression/regression of coronary artery disease?. Heart 92: 1187-1188 [Abstract] [Full Text]