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Statin Therapy Reduces Coronary Noncalcified Plaque Volume in HIV Patients: A Randomized Controlled Trial
Janet Lo1, Michael Lu2, Ezinne Ihenachor1, Jeffrey Wei1, Sara Looby1, Kathleen Fitch1, Suhny Abbara2, Gregory Robbins1, Udo Hoffmann2, Steven Grinspoon1
1 Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. 2 Massachusetts General Hospital, Boston, MA, United States.
Background: Statins reduce cardiovascular events and deter progression of atherosclerosis. No studies have yet assessed the ability of statin treatment to achieve regression of coronary atherosclerosis in HIV-infected patients, a population demonstrated to have elevated risk of myocardial infarction.
Methods: In a randomized, double-blind, placebo-controlled trial, 40 HIV-infected participants with subclinical coronary atherosclerosis and low density lipoprotein (LDL)-cholesterol < 130mg/dL were randomized to one year of treatment with atorvastatin or placebo to determine the effect on coronary atherosclerotic plaque as assessed by coronary computed tomography angiography. We quantitatively assessed non-calcified plaque and high risk plaque features (low attenuation, spotty calcification, and positive remodeling index).
Results: After 12 months, atorvastatin reduced noncalcified coronary plaque volume compared to placebo (-19.4% [-39.2%, 9.3%] vs. +20.4% [-7.1%, 94.4%], p=0.009). In addition, the number of high risk plaques was significantly reduced by atorvastatin compared to placebo (change in number of low attenuation plaques -0.2 ± 0.8 vs. 0.4 ± 0.7 lesions, p=0.03 and change in number of positively remodeled plaques -0.2 ± 0.5 vs. 0.4 ± 0.9, p=0.04). Direct LDL-cholesterol (-38 ± 29 vs. 11 ± 21 mg/dL, p<0.0001) and lipoprotein-associated phospholipase A2 (-52.2 ± 36.6 vs. -13.3 ± 42.8 ng/dL, p=0.005) significantly decreased with atorvastatin compared to placebo. Statin therapy was well-tolerated, with low incidence of clinical adverse events or laboratory abnormalities.
Conclusions: As compared to placebo, statin therapy reduces noncalcified plaque volume and high risk plaque features in HIV-infected patients with subclinical coronary atherosclerosis. Further studies should assess whether reduction in high risk coronary artery disease may translate into effective prevention of cardiovascular events in this at risk population of HIV patients.