1. Individual coronary plaque changes on serial CT angiography: Within-patient heterogeneity, natural history, and statin effects in HIV
- Author
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Michael T. Lu, Udo Hoffmann, Borek Foldyna, Steven K. Grinspoon, Janet Lo, and Thomas Mayrhofer
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Statin ,Computed Tomography Angiography ,medicine.drug_class ,Atorvastatin ,Population ,HIV Infections ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Placebo ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Coronary atherosclerosis ,Computed tomography angiography ,Subclinical infection ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Plaque, Atherosclerotic ,Treatment Outcome ,Asymptomatic Diseases ,Angiography ,Cardiology ,Female ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background It is not known how the volume and composition of individual coronary plaques change over time in HIV-infected people and whether statins influence these changes. Methods We included forty adults with HIV and subclinical coronary atherosclerosis who participated in a randomized controlled trial of placebo vs. atorvastatin. All participants underwent serial coronary computed tomography angiography at baseline and after one year. Individual coronary plaques were measured to assess the within-patient variability of plaque volume and composition changes. Left-main, proximal-right, proximal-left-anterior descending, and proximal-circumflex coronary segments were considered proximal. Plaque voxels with attenuation ≤130 Hounsfield Units (HU) were defined as noncalcified and further divided into fatty ( Results In 37 patients who completed the trial, there were 92 coronary plaques. Individual plaque changes varied highly, with some plaques increasing while others decreased in the same patient. Overall, 77% vs. 51% of individual plaques progressed, while 24% vs. 49% regressed in placebo and statin, respectively (p = 0.016). Substantial increases in proximal plaques drove the progression in placebo. Statins suppressed these large increases, resulting in a 3-fold lower variance in plaque volume change compared to placebo (p = 0.025). Statins suppressed progression of fibrotic (p = 0.015) plaque, with a trend towards reducing fatty (p = 0.075) plaque and no significant effect on the calcified portion (p = 0.203). Conclusion In persons with HIV, a population with increased atherosclerosis burden and cardiovascular risk, individual coronary plaque changes vary within a given individual. Large increases in proximal plaques characterize progression, and statins act in part by stabilizing progressing plaques by reducing fatty and fibrotic plaque components, without influencing the calcified portion.
- Published
- 2020