Is there a risk of rhabdomyolysis from statins? Figure 1: Courtesy of Kazzi BE, Feldman DI, Blumenthal RS, Zadeh AA. Risk factors include: Grapefruit juice contains a chemical that can interfere with the enzymes that break down (metabolize) the statins in your digestive system. 8600 Rockville Pike Alonso R, et al. Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary artery calcium scoring: is it time for a change in methodology. The ability to show someone their plaques and say, If we aggressively treat your lipids, we are going to cool down the plaques that will cause a heart attack, can be motivating for many patients, Nicholls told TCTMD. The food containing the highest amount of Vitamin K2 is a highly fermented soy food called natto, which very few people can tolerate given its strong odor and flavor. health information, we will treat all of that information as protected health Adverse effects of statin therapy: Perception vs. the evidence focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. 2021 Mar 21;117(4):1070-1077. doi: 10.1093/cvr/cvaa184. CCTA evaluated all coronary arteries, including side branches that were at least 2 mm in diameter. HMG Co-A reductase inhibitors (atorvastatin) Which drug's Mechanism of action is Upregulation of LDL receptors that remove LDL from the blood stream HMG Co-A reductase inhibitors (atorvastatin) Rationale: Statins upregulate the LDL receptors on the liver, and that removes LDL (the bad cholesterol from the bloodstream). It showed that the risks of long-term use of statin drugs are low and the potential benefits are very high. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Cholesterol medications: Consider the options. Past studies have shown that the burden of atherosclerosis in the coronary tree is a strong predictor of future coronary events, said van Rosendael, but refining the risks associated with different components of coronary plaque is currently an important area of research. These side effects reverse once you stop taking the medication. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). Type 2 diabetes or high blood sugar. Complicating interpretation is the inclusion of only fatal events and the relatively elevated, but still low, mortality rate in statin users versus non-users with a zero CAC score. Statin therapy contributes to plaque-stability by increasing the presence of calcification of plaque. Commentary based on: van Rosendael AR, van den Hoogen IJ, Gianni U, et al. Having too much cholesterol in your blood increases your risk of heart attacks and strokes. However, researchers have found a "nocebo" effect when it comes to perceived muscle pain and statins. [Evaluation of carotid atherosclerotic plaques by vascular plaque quantification (VPQ) technology of three-dimensional ultrasonography]. We used logistic regression models to study the association of statin use with the presence of plaque components. . Mitigation of Cardiovascular Disease and Toxicity through NRF2 Signalling. 3 Statins are the most widely prescribed and evidence-based lipid-lowering drug in the world for lowering LDL-c and reducing cardiovascular morbidity and mortality, both in primary and secondary prevention. In: Ferri's Clinical Advisor 2019. information and will only use or disclose that information as set forth in our notice of If tolerated, intravenous beta blockage (5-20 mg Seloken, Astra Zeneca) was used to reduce the heart rhythm and Nitroglycerin 0.4mg (Nitrolingual, Pohl-Boskamp, Hohenlockstedt, Germany) was administered for the vasodilating effect sublingually 1-3 minutes prior to the contrast-enhanced scan. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Those who were treated were older, more commonly male, and more likely to have diabetes and hypertension. of 28,000 participants from the CAC Consortium. Cholesterol test kits: Are they accurate? Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; P = 0.001) and fibro-fatty plaque volumes ( -0.03; P < 0.001) compared with no therapy. Some drugs that may interact with statins and increase your risk of side effects include: There are many drugs that may interact with statins, so be sure your doctor is aware of all the medicines you take when being prescribed with statins. While CAC scores are a strong predictor of future events, the score incorporates both calcified and noncalcified plaques. Association of coronary artery calcium in adults aged 32 to 46 years with incident coronary heart disease and death. Cardoso R, Dudum R, Ferraro RA, et al. Statins represent a key treatment for cardiovascular disease. He completed his undergraduate degrees at Queens. In patients on a statin, coronary lesions had a lower volume of low-attenuation plaques and a higher volume of calcium-containing plaques. Atorvastatin and fluvastatin are preferred in people with kidney disease. Notably, statins play a role in plaque regression with reduction in lipid content. Although liver problems are rare, your doctor may order a liver enzyme test before or shortly after you begin to take a statin. The benefit of statins on exercise tolerance may be greater in patients with moderate-severe arterial stenosis (defined as an ABI <0.7) than in those with mild stenosis, which has been attributed to a possible regression and stability of the atheroma plaque in cases of more advanced atherosclerotic lesions with a higher lipid load on the plaque . Anyanwagu U, et al. 2022 Jun 28;22(1):237. doi: 10.1186/s12883-022-02758-3. official website and that any information you provide is encrypted Statin side effects Weigh the benefits and risks, Advertising and sponsorship opportunities, Taking multiple medications to lower your cholesterol, Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS), Amiodarone (Cordarone, Pacerone), a medication for irregular heart rhythms, Gemfibrozil (Lopid), another variety of cholesterol drug, HIV treatments called protease inhibitors such as saquinavir (Invirase) and ritonavir (Norvir), Some antibiotic and antifungal medications, such as clarithromycin and itraconazole (Onmel, Sporanox), Some immunosuppressant medications, such as cyclosporine (Gengraf, Neoral, Sandimmune). 2019 Nov;29(8):456-457. doi: 10.1016/j.tcm.2019.02.001. High dose and long-term statin therapy accelerate coronary artery calcification. Guo BC, Kuo KL, Huang JW, Chen CH, Tarng DC, Lee TS. Atorvastatin and simvastatin are the most effective at reducing LDL cholesterol levels. Carotid plaque regression following 6-month statin therapy assessed by 3T cardiovascular magnetic resonance: comparison with ultrasound intima media thickness. On average, subjects in both groups showed a 9.2 percent increase in plaque buildup. Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK. Nature Reviews Cardiology. The https:// ensures that you are connecting to the Coronary artery calcium score for long-term risk classification in individuals with type 2 diabetes and metabolic syndrome from the Multi-Ethnic Study of Atherosclerosis. You wouldn't need any additional liver enzyme tests unless you begin to have signs or symptoms of trouble with your liver. Accessibility Ann Med Surg (Lond). Second, most research on the allocation of add-on therapies guided by CAC implicitly assumed that baseline rather than follow-up CAC scores would inform such allocation, and that this would happen in mostly statin-nave populations.26,28,29 Accordingly, in patients with an initial (first) CAC scan >100, it may be reasonable to initiate not only statins, but also other relevant preventive medications early on without the need for repeat CAC scanning later in time. The elevated mortality rate is likely due to higher burden of cardiovascular risk factors and indication bias, although the point estimates for CVD events were significantly lower in users compared to nonusers. Statin drugs have been shown to reduce serum cholesterol along with significant reduction in morbidity and mortality of cardiovascular disease. [Association of statin treatment with progression of coronary atherosclerotic plaque composition. Bethesda, MD 20894, Web Policies Statin intolerance. 7 Coincidentally, in the period from 1900 to 1960 . Atherosclerosis; Carotid artery; Epidemiology; MRI; Plaque composition; Statin. HHS Vulnerability Disclosure, Help Invasive Cardiovascular Angiography and Intervention. Artificial Sweetener Erythritols Major Health Risks, Best Ingredients and Products for Your Anti-Aging Skin Care Routine. PMC The risk is small but important enough that the Food and Drug Administration (FDA) has issued a warning on statin labels regarding blood glucose levels and diabetes. In the statin-treated group, LDL-cholesterol levels were slightly lower than in the untreated group at baseline (107 vs 113 mg/dL; Statin treatment, which included a mix of moderate- and high-intensity statins, was associated with larger decreases in low-attenuation ( -0.02; That seesaw-like transformation isnt one to one, said van Rosendael, because the overall plaque progression is slower in the statin-treated patients. However, which statin is more effective for the reversion of coronary atherosclerotic plaques remains inconclusive. Impact of statins on serial coronary calcification during atheroma progression and regression. In contrast, statin therapy was associated with larger increases in high-density calcium volume and 1K plaque (both 0.02; P < 0.001). The effect of CAC score on predictive value by AUROC are summarized in Table 2. The progression of atherosclerotic plaque composition has been previously described with intravascular ultrasound and CCTA. Min JK, Dunning A, Lin FY, et al. Coronary atherosclerotic precursors of acute coronary syndromes. Total CAC and volume holds prognostic value in statin users; however, the effects of statin on plaque histology requires clinicians to interpret CAC scores while accounting for statin use. Cerebrovasc Dis. Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease. The pain can be a mild discomfort, or it can be severe enough to make your daily activities difficult. Hypothyroidism symptoms: Can hypothyroidism cause eye problems? We know that statins reduce the risk of heart attacksthats been proven many, many timesso we wanted to know whether statins increase the good plaque, the very dense calcium, and decrease the very-high-risk plaque.. A bit like any other. 2018;12:757. Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Novel Agents, Primary Hyperlipidemia, Statins, Keywords: Dyslipidemias, Calcium, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiovascular Diseases, Coronary Vessels, Hyperlipoproteinemia Type II, Secondary Prevention, Research Design, Reference Values, Prognosis, Retrospective Studies, Follow-Up Studies, Area Under Curve, Coronary Disease, Risk Factors, Risk Assessment, Diabetes Mellitus, Diabetes Mellitus, Risk Reduction Behavior, Chest Pain, Atherosclerosis, Cardiology, Reference Standards, Acceleration, Aspirin, Lipids, Resource Allocation. These drugs further stabilize atherosclerotic plaque with thickened fibrous caps and macrocalcification that serves to stabilize atheromas. To better understand the changes associated with statin therapy on certain plaque subtypes, the authors enrolled 2,252 patients from the CCTA PARADIGM study. High dose and long-term statin therapy accelerate coronary artery calcification. The Role of Inflammation in Cardiovascular Disease. 2022;80(9):880-890. doi: 10.33963/KP.a2022.0155. The German Atorvastatin Study demonstrated that hyperechogenicity of plaques significantly increased after 12 months compared with non-statin-based lipid lowering. Careers. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018. 2023 Feb 14;12(2):477. doi: 10.3390/antiox12020477. Plaque characterization by coronary computed tomography angiography and the likelihood of acute coronary events in mid-term follow-up. Macroscopic calcification is uncommon in the early stages of atherosclerosis while its invariable presence during its later stages likely is related to decreasing inflammation and organization. 2018;39:2526. Xing HY, Chen YH, Xu K, Huang DD, Peng Q, Liu R, Sun W, Huang YN. The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. Mortensen MB, Steffensen FH, Btker HE, et al. The population of statin users with high CAC scores therefore encompasses very high-risk individuals and individuals with highly stable plaques at relatively lower risk of events. People with. 2023 Apr 4;24(7):6723. doi: 10.3390/ijms24076723. Detrano R, Guerci AD, Carr JJ, et al. The study excluded patients with noninterpretable CCTA findings, patients without lesions at baseline as well as at follow-up, patients initiating or stopping statin after baseline CCTA, patients with unknown information regarding statin use, and those with tandem lesions at baseline that were confluent at follow-up. We aimed to investigate the association of statin treatment with the presence of different plaque components located in the carotid arteries within a population-based setting. AUC analyses were performed to assess whether CAC, volume, and density improved prediction beyond traditional risk factors. Nuts and your heart: Eating nuts for heart health. If we look at the lesions not treated with statins, we see that all six components of the coronary plaque increase, he said, referring to low-attenuation, fibro-fatty, fibrous, and low-, high-, and very-high-density calcium (1K) plaque components. 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