Journal Article Ahead of print
PubMed: 42841236 DOI: 10.1093/cvr/cvag174
Improved plaque composition from intensive medical treatment in women with angina and non-obstructive coronary disease.
Cardiovasc Res
Authors: Joel Lenell, Guadalupe Flores Tomasino, Donghee Han, Rafal Wolny, Caroline Park, Kajetan Grodecki, Jacek Kwiecinski, Emily Xing, Nipun Manral, Folahanmi Asebiomo, Divyani Goyal, Vinicius F Calsavara, Osama Dasa, Daniel S Berman, Piotr J Slomka, Matthew Budoff, Eileen Handberg, Colin Berry, Carl J Pepine, Janet Wei, Leslee Shaw, Martha Gulati, Noel Bairey Merz, Balaji Tamarappoo, Damini Dey
Affiliations
- Biomedical Imaging Research Institute, Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA 90048, USA.
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
- Biostatistics Shared Resource, Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA USA.
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
- School of Cardiovascular and Metabolic Health, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK.
- Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Blavatnik Family Women's Health Research Institute, Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
Abstract
AIMS
Among women with suspected ischaemia and non-obstructive coronary artery disease (INOCA), the temporal effect of combination intensive medical treatment (IMT) with angiotensin-converting enzyme inhibitors or receptor blockers, statins, and aspirin on coronary plaque composition is not known. This prospective ancillary study examined changes in atherosclerotic plaque volumes and composition (percentage of total plaque volume) over time between IMT and usual care (UC).
METHODS AND RESULTS
Participants from the randomized WARRIOR trial with the presence of plaque on their first coronary computed tomography angiography (CCTA) were enrolled for a follow-up CCTA at least 2 years after randomization. Volumes and volumetric composition (percentage of total plaque volume) of non-calcified plaque (NCP), low-density NCP (LD-NCP, defined as NCP <30 HU), and calcified plaque (CP) were quantified over the coronary tree in the serial scans.Participants (n = 186) completed both scans with good image quality (94 IMT arm and 92 UC arm). Overall mean age was 61.0 years (SD ±10.9), and there were no statistically significant differences in baseline risk factors, plaque volumes, or statin treatment between the arms.There was a greater bi-annualized increase in CP volume [ΔCP volume (mm3)] in the IMT arm, 6.2 (SD ±15.5) compared to the UC arm, 3.9 (SD ±16.0), P = 0.013, and a consistent greater reduction in NCP composition [ΔNCP composition (%)] in the IMT arm, -3.9 (SD ±7.7) compared to the UC arm, -1.5 (SD ±5.8), P = 0.003, with no increase in total plaque volume.
CONCLUSION
In women with suspected INOCA, IMT reduces NCP volumetric composition to a greater extent than UC and may promote plaque stabilization.
MeSH
Coronary Disease, Therapeutics, Hydroxymethylglutaryl-Coa Reductase Inhibitors