The following is the summary of “Association of Statins With Nonculprit Coronary Lesions and Adverse Events (from the LRP Study)” published in the December 2022 issue of Cardiovascular Disease by Case, et al.
Coronary atherosclerotic plaques at risk of rupture can be detected using intravascular ultrasonography and near-infrared spectroscopy. This LRP (Lipid-Rich Plaque) substudy aimed to determine whether or not statins were linked to a reduction in the lipidic content of the arterial wall around nonculprit lesions and a reduction in the risk of major adverse cardiac events in patients without such lesions. Inclusion criteria required patients to have enrolled in the LRP research and previously used statins. After classifying patients into “statin therapy” and “statin-naive” groups, researchers went on to describe the intravascular ultrasonography and near-infrared spectroscopy analyses based on the maximal 4mm lipid core burden index (maxLCBI4mm).
Clinical events were evaluated at the 2-year follow-up period for each patient based on the statin regimen change that occurred at the time of discharge. Statin intensity upon discharge was then used to divide patients into groups. Out of the total of 1,526 individuals, 1,120 were already taking a statin and 396 were statin-naive when they were seen. The maxLCBI4mm did not differ between the 2 groups (315.67 181.36 vs 325.55 192.16; P=0.359) despite the fact that statin-naive patients were more likely to present with an acute coronary syndrome and that patients taking statins at baseline had a greater prevalence of cardiovascular risk factors. A secondary evaluation of statin intensity confirmed these results. Nonculprit significant adverse cardiac events were reduced in individuals who were transferred from no statin to a statin, compared to those who were already on a statin at baseline but did not alter their dosage.
In conclusion, patients on a statin at baseline had equivalent maxLCBI4mm with patients who were statin-naive, regardless of intensity, despite having a larger burden of nonlipid-related cardiac co-morbidities. The greatest benefit for events attributable to nonculprit lesions is seen when treatment with a statin is initiated upon discharge.