Coronary atherosclerotic plaque progression: contributing factors in statin-treated patients

ABSTRACT

Introduction: Coronary atheroma progression correlates with adverse cardiovascular events among individuals with coronary artery disease. Atherosclerosis imaging, including coronary intravascular ultrasound (IVUS), has provided novel insights into the biologic contributors to atheroma progression or regression, improving the efficiency of drug development by identifying therapies most likely to succeed in clinical outcomes trials.

Areas covered: Despite widespread use of statins, residual risk for adverse events is high among individuals with cardiovascular disease receiving optimal medical therapy. This review outlines current studies, including patient-level analyses of large randomized clinical trials, demonstrating several factors that associate with coronary plaque progression in the context of statin therapies.

Expert opinion: Atherosclerotic plaque remains a fundamental substrate underlying the occurrence of ischemic events in the current era of cardiovascular care. Understanding pathobiologic contributors to atherosclerosis, targeting treatment pathways, generating high-quality data, and implementing evidence into clinical practice are necessary to improve outcomes among patients with atherosclerotic disease.

KEYWORDS:

• Lipoproteins
• atherosclerosis
• coronary disease

Article Highlights

• Coronary atheroma progression correlates with adverse cardiovascular events among individuals with coronary artery disease.

• Atherosclerosis imaging, including coronary intravascular ultrasound (IVUS), has provided novel insights into the biologic contributors to atheroma progression or regression.

• Several factors associate with coronary plaque progression in the context of statin therapies including LDL-C, non-HDL-C, TC/HDL-C, remnant cholesterol, triglycerides, and lipoprotein variability.

• Non-lipid cardiovascular risk factors including hypertension, chronic kidney disease, and inflammation are important contributors to cardiovascular events.

• Further research is required to identify additional treatments to address the high residual risk for adverse events among patients with cardiovascular disease.

Declaration of interest

D Clark III reports research grant funding from the American Heart Association. SE Nissen reports that the Cleveland Clinic Center for Clinical Research has received funding to perform clinical trials from Abbvie, AstraZeneca, Amgen, Cerenis, Eli Lilly, Esperion, Medtronic, MyoKardia, Novartis, Pfizer, The Medicines Company, Silence Therapeutics, Takeda, and Orexigen. SE Nissen is involved in these clinical trials but receives no personal remuneration for his participation. SE Nissen consults for many pharmaceutical companies, but requires them to donate all honoraria or consulting fees directly to charity so that he receives neither income nor a tax deduction. R Puri reports consulting fees from Amgen, Sanofi, and Cerenis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.