Will an intensive statin treatment change composition of plaque?

This paper studied the effect of an early intensive statin treatment in patients who have had a heart attack.

Plaque occurs when fat (cholesterol, for example) and other types of cells (calcium, for example) build up into a waxy substance in the blood vessels. When these plaques rupture, they can obstruct the blood vessel and block blood from flowing. This causes heart attacks. Studies have found that some plaques are more prone to rupture than others, and it depends on the composition of the plaque. These plaques often have lower levels of calcium. Statins are a group of drugs that are used to stabilize vulnerable plaques from rupturing. They work by reducing the levels of unhealthy cholesterol in the body.

The authors studied how statin treatment changed the composition of plaques. A coronary CT angiography (scan to look at blood vessels supplying the heart) was used to measure plaque composition. 96 patients who had an acute (sudden and severe) heart attack were studied.

48 patients received an intensive statin treatment (a high dose of statins followed by a lower dose). 48 patients received the usual care (a steady dose of statins). At 12 months follow-up, the average total cholesterol level was 3.1 mmol/l and the average levels of unhealthy cholesterol was 1.3 mmol/l for patients receiving intensive statin treatment. For patients receiving usual care, the average total cholesterol level was 4.1 mmol/l and the average levels of unhealthy cholesterol was 2.0 mmol/l.

Among patients receiving intensive care, the average plaque volume increased by 2% over 12 months. Among patients receiving usual care, the average plaque volume increased by 1% over 12 months. The volume of calcium increased by 23% among patients receiving intensive care and decreased by 0.7% among patients receiving usual care.

Among patients receiving intensive care, 2 patients had another heart attack. 6 patients had symptoms of ischaemia (not enough blood flow). Among patients receiving usual care, 1 patient had another heart attack. 8 patients had symptoms of ischaemia. Between the two groups of patients, there was no significant difference in how vulnerable the plaque was to rupture.

The authors concluded that early intensive statin therapy increased the volume of calcium in patients who had a heart attack.