Interaction Between Statin Use, Coronary Artery Disease Phenotypes, on Computed Tomography Angiography, and Cardiovascular Outcomes (JIMG October 2025)-Article: Interaction Between Statin Use, Coronary Artery Disease Phenotypes, on Computed Tomography Angiography, and Cardiovascular Outcomes

Article: Interaction Between Statin Use, Coronary Artery Disease Phenotypes, on Computed Tomography Angiography, and Cardiovascular Outcomes

Back to course

Pdf Summary

This large retrospective study evaluated the relationship between statin therapy and cardiovascular outcomes among 11,026 patients with stable chest pain undergoing coronary computed tomography angiography (CTA). Statin use was quantified precisely by the number of days patients redeemed statin prescriptions during follow-up (median 8.33 years). The primary outcome was major adverse cardiac events (MACE), a composite of all-cause mortality, myocardial infarction (MI), or revascularization for unstable angina.<br /><br />Key findings include:<br /><br />1. Statins reduced MACE risk significantly only in patients with coronary artery disease (CAD) evident on CTA, not in patients without CAD.<br />2. The efficacy of statins increased with CAD severity and extent, defined by parameters such as obstructive CAD (≥50% stenosis), high-risk plaque features, coronary artery calcium score (CACS) ≥400, and segment involvement score (SIS) ≥4.<br />3. A 10% increase in statin use over follow-up was associated with reduced MACE risk specifically in patients with obstructive CAD (adjusted hazard ratio [aHR]: 0.91), high-risk plaques (aHR: 0.82), CACS≥400 (aHR: 0.93), and SIS≥4 (aHR: 0.90), but not in patients with any CAD or without CAD.<br />4. Coronary CTA findings strongly influenced statin therapy initiation or discontinuation decisions. Notably, some patients with extensive calcification (CACS≥400) did not receive statins.<br />5. Thresholds for statin benefit were identified via Johnson-Neyman analyses: statins provided significant protection when SIS exceeded ~4 and CACS exceeded ~17.<br />6. Statins reduced mortality and MI in specific subgroups but showed sex differences, with stronger protective effects in men with higher SIS or obstructive CAD.<br />7. The study highlights the importance of detailed CAD phenotyping via coronary CTA to guide personalized statin allocation, optimizing prevention of adverse events.<br />8. Limitations include lack of cholesterol data, statin dose/type not considered, and inherent observational biases.<br /><br />In summary, the study suggests that statin therapy should be targeted to patients with CTA-demonstrated CAD phenotypes indicating higher disease burden or vulnerability, as statins confer little benefit in patients without plaque. Coronary CTA serves as an effective tool to personalize cardiovascular prevention by identifying whom to treat with statins, thereby enhancing outcomes and resource utilization. These findings support evolving guidelines incorporating imaging to refine statin therapy decisions.

Keywords

statin therapy

coronary computed tomography angiography

stable chest pain

major adverse cardiac events

coronary artery disease

obstructive CAD

high-risk plaque

coronary artery calcium score

segment involvement score

personalized cardiovascular prevention