Research Article| Volume 225, ISSUE 1, P148-153, November 2012

Statins use and coronary artery plaque composition: Results from the International Multicenter CONFIRM Registry



      The effect of statins on coronary artery plaque features beyond stenosis severity is not known. Coronary CT angiography (CCTA) is a novel non-invasive method that permits direct visualization of coronary atherosclerotic features, including plaque composition. We evaluated the association of statin use to coronary plaque composition type in patients without known coronary artery disease (CAD) undergoing CCTA.


      From consecutive individuals, we identified 6673 individuals (2413 on statin therapy and 4260 not on statin therapy) with no known CAD and available statin use status. We studied the relationship between statin use and the presence and extent of specific plaque composition types, which was graded as non-calcified (NCP), mixed (MP), or calcified (CP) plaque.


      The mean age was 59 ± 11 (55% male). Compared to the individuals not taking statins, those taking statins had higher prevalence of risk factors and obstructive CAD. In multivariable analyses, statin use was associated with increased the presence of MP [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.27–1.68), p < 0.001] and CP (OR 1.54, 95% CI 1.36–1.74, p < 0.001), but not NCP (OR 1.11, 95% CI 0.96–1.29, p = 0.1). Further, in multivariable analyses, statin use was associated with increasing numbers of coronary segments possessing MP (OR 1.52, 95% CI 1.34–1.73, p < 0.001) and CP (OR 1.52, 95% CI 1.36–1.70, p < 0.001), but not coronary segments with NCP (OR 1.09, 95% CI 0.94–1.25, p = 0.2).


      Statin use is associated with an increased prevalence and extent of coronary plaques possessing calcium. The longitudinal effect of statins on coronary plaque composition warrants further investigation.


      • We evaluate association of statin use to coronary plaque composition.
      • Statin was associated with increased prevalence of calcified plaque (CP).
      • Statin was associated with increasing numbers of coronary segments possessing CP.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • et al.
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Nissen S.E.
        • Tuzcu E.M.
        • Schoenhagen P.
        • et al.
        Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease.
        N Engl J Med. 2005; 352: 29-38
        • Ray K.K.
        • Cannon C.P.
        The potential relevance of the multiple lipid-independent (pleiotropic) effects of statins in the management of acute coronary syndromes.
        J Am Coll Cardiol. 2005; 46: 1425-1433
        • Jensen L.O.
        • Thayssen P.
        • Pedersen K.E.
        • et al.
        Regression of coronary atherosclerosis by simvastatin: a serial intravascular ultrasound study.
        Circulation. 2004; 110: 265-270
        • Nissen S.E.
        • Tuzcu E.M.
        • Schoenhagen P.
        • et al.
        Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial.
        JAMA. 2004; 291: 1071-1080
        • Hattori K.
        • Ozaki Y.
        • Ismail T.F.
        • et al.
        Impact of statin therapy on plaque characteristics as assessed by serial OCT, grayscale and integrated backscatter-IVUS.
        JACC Cardiovasc Imaging. 2012; 5: 169-177
        • Schuetz G.M.
        • Zacharopoulou N.M.
        • Schlattmann P.
        • et al.
        Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging.
        Ann Intern Med. 2010; 152: 167-177
        • Pundziute G.
        • Schuijf J.D.
        • Jukema J.W.
        • et al.
        Head-to-head comparison of coronary plaque evaluation between multislice computed tomography and intravascular ultrasound radiofrequency data analysis.
        JACC Cardiovasc Interv. 2008; 1: 176-182
        • Lin F.
        • Shaw L.J.
        • Berman D.S.
        • et al.
        Multidetector computed tomography coronary artery plaque predictors of stress-induced myocardial ischemia by SPECT.
        Atherosclerosis. 2008; 197: 700-709
        • Pundziute G.
        • Schuijf J.D.
        • Jukema J.W.
        • et al.
        Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease.
        J Am Coll Cardiol. 2007; 49: 62-70
        • Min J.K.
        • Dunning A.
        • Lin F.Y.
        • et al.
        Rationale and design of the CONFIRM (Coronary CT Angiography Evaluation For Clinical Outcomes: An International Multicenter) Registry.
        J Cardiovasc Comput Tomogr. 2011; 5: 84-92
        • Raff G.
        • Abidov A.
        • Achenbach S.
        • et al.
        SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography.
        J Cardiovasc Comput Tomogr. 2009; 3: 122-136
        • Austen W.G.
        • Edwards J.E.
        • Frye R.L.
        • et al.
        A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association.
        Circulation. 1975; 51: 5-40
        • Min J.
        • Shaw L.
        • Devereux R.
        • et al.
        Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality.
        J Am Coll Cardiol. 2007; 50: 1161-1170
        • Expert Panel on Detection, Ea, and Treatment of High Blood Cholesterol in Adults
        Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in Adults (Adult treatment Panel III).
        JAMA. 2001; 285: 2486-2497
        • Nissen S.E.
        • Nicholls S.J.
        • Sipahi I.
        • et al.
        Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial.
        JAMA. 2006; 295: 1556-1565
        • Schartl M.
        • Bocksch W.
        • Koschyk D.H.
        • et al.
        Use of intravascular ultrasound to compare effects of different strategies of lipid-lowering therapy on plaque volume and composition in patients with coronary artery disease.
        Circulation. 2001; 104: 387-392
        • Cheng V.
        • Wolak A.
        • Gutstein A.
        • et al.
        Low-density lipoprotein and noncalcified coronary plaque composition in patients with newly diagnosed coronary artery disease on computed tomographic angiography.
        Am J Cardiol. 2010; 105: 761-766
        • Burgstahler C.
        • Reimann A.
        • Beck T.
        • et al.
        Influence of a lipid-lowering therapy on calcified and noncalcified coronary plaques monitored by multislice detector computed tomography: results of the New Age II Pilot Study.
        Invest Radiol. 2007; 42: 189-195
        • Inoue K.
        • Motoyama S.
        • Sarai M.
        • et al.
        Serial coronary CT angiography-verified changes in plaque characteristics as an end point: evaluation of effect of statin intervention.
        JACC Cardiovasc Imaging. 2010; 3: 691-698
        • Kitagawa T.
        • Yamamoto H.
        • Horiguchi J.
        • et al.
        Effects of statin therapy on non-calcified coronary plaque assessed by 64-slice computed tomography.
        Int J Cardiol. 2011; 150: 146-150
        • Raggi P.
        • Davidson M.
        • Callister T.Q.
        • et al.
        Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic postmenopausal women: beyond endorsed lipid lowering with EBT scanning (BELLES).
        Circulation. 2005; 112: 563-571
        • Schmermund A.
        • Achenbach S.
        • Budde T.
        • et al.
        Effect of intensive versus standard lipid-lowering treatment with atorvastatin on the progression of calcified coronary atherosclerosis over 12 months: a multicenter, randomized, double-blind trial.
        Circulation. 2006; 113: 427-437
        • Hansson G.K.
        Inflammation, atherosclerosis, and coronary artery disease.
        N Engl J Med. 2005; 352: 1685-1695
        • Motoyama S.
        • Sarai M.
        • Harigaya H.
        • et al.
        Computed tomographic angiography characteristics of atherosclerotic plaques subsequently resulting in acute coronary syndrome.
        J Am Coll Cardiol. 2009; 54: 49-57
        • Marwan M.
        • Taher M.A.
        • El Meniawy K.
        • et al.
        In vivo CT detection of lipid-rich coronary artery atherosclerotic plaques using quantitative histogram analysis: a head to head comparison with IVUS.
        Atherosclerosis. 2011; 215: 110-115
        • Voros S.
        • Rinehart S.
        • Qian Z.
        • et al.
        Prospective validation of standardized, 3-dimensional, quantitative coronary computed tomographic plaque measurements using radiofrequency backscatter intravascular ultrasound as reference standard in intermediate coronary arterial lesions: results from the ATLANTA (assessment of tissue characteristics, lesion morphology, and hemodynamics by angiography with fractional flow reserve, intravascular ultrasound and virtual histology, and noninvasive computed tomography in atherosclerotic plaques) I study.
        JACC Cardiovasc Interv. 2011; 4: 198-208
        • Motoyama S.
        • Kondo T.
        • Sarai M.
        • et al.
        Multislice computed tomographic characteristics of coronary lesions in acute coronary syndromes.
        J Am Coll Cardiol. 2007; 50: 319-326