Impact of statin therapy on coronary plaque composition: a systematic review and meta-analysis of virtual histology intravascular ultrasound studies

Authors:

Maciej Banach | Corina Serban | Amirhossein Sahebkar | Dimitri P. Mikhailidis | Sorin Ursoniu | Kausik K. Ray | Jacek Rysz | Peter P. Toth | Paul Muntner | Svetlana Mosteoru | Hector M. García-García | G. Kees Hovingh | John JP Kastelein | Patrick W. Serruys | Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group

First published: 2015 Sep 18 | https://doi.org/10.1186%2Fs12916-015-0459-4

Abstract:

Background
Virtual histology intravascular ultrasound (VH-IVUS) imaging is an innovative tool for the morphological evaluation of coronary atherosclerosis. Evidence for the effects of statin therapy on VH-IVUS parameters have been inconclusive. Consequently, we performed a systematic review and meta-analysis to investigate the impact of statin therapy on plaque volume and its composition using VH-IVUS.

Methods

The search included PubMed, Cochrane Library, Scopus and Embase (through 30 November 2014) to identify prospective studies investigating the effects of statin therapy on plaque volume and its composition using VH-IVUS.

Results

We identified nine studies with 16 statin treatment arms and 830 participants. There was a significant effect of statin therapy in reducing plaque volume (standardized mean difference (SMD): −0.137, 95 % confidence interval (CI): −0.255, −0.019; P = 0.023), external elastic membrane volume (SMD: −0.097, 95 % CI: −0.183, −0.011; P = 0.027) but not lumen volume (SMD: −0.025, 95 % CI: −0.110, +0.061; P = 0.574). There was a significant reduction in fibrous plaque volume (SMD: −0.129, 95 % CI: −0.255, −0.003; P = 0.045) and an increase of dense calcium volume (SMD: +0.229, 95 % CI: +0.008, +0.450; P = 0.043), while changes in fibro-fatty (SMD: −0.247, 95 % CI: −0.592, +0.098; P = 0.16) and necrotic core (SMD: +0.011, 95 % CI: −0.144, +0.165; P = 0.892) tissue volumes were not statistically significant.
ConclusionsThis meta-analysis indicates a significant effect of statin therapy on plaque and external elastic membrane volumes and fibrous and dense calcium volumes. There was no effect on lumen volume, fibro-fatty and necrotic tissue volumes.

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Footnotes

Maciej Banach and Corina Serban contributed equally to this work.

Competing interests
MB reports honoraria for lectures from: Amgen, Sanofi, Abbott, MSD/Merck, he is consultant/member of an international advisory board in Amgen, Sanofi, Daiichi Sankyo, Resverlogix and Abbott Vascular, reports grants from VALLEANT; DPM has given talks and attended conferences sponsored by MSD, AstraZeneca and Libytec; KKR reports honoraria for lectures from: Novo Nordisk, Roche, Novartis, Pfizer, AstraZeneca, Daiichi Sankyo, Lilly, he is consultant/member of advisory board in: Novo Nordisk, Roche, Novartis, Pfizer, AstraZeneca, Daiichi Sankyo, Lilly, Merck; PPT reports honoraria for lectures from: Amgen, Amarin, AstraZeneca, GSK, Kowa, Merck, he is consultant/member of advisory board in: Amgen, AstraZeneca, Kowa, Merck, Novartis; PM reports grants, personal fees and other from Amgen; GKH reports that his institution receives funding from Dezima, Amgen, Pfizer, Sanofi, Regeneron, AstraZeneca, Genzyme, Cerenis, Synageva, Roche, ISIS pharmaceuticals, Kowa, and Merck for undertaking clinical trials related to various forms of lipid-lowering medication and he reports consulting fees from: Amgen, Pfizer, Roche, and Sanofi; JJP reports personal fees from Dezima Pharmaceuticals, Cerenis, The Medicines Company, CSL Behring, Amgen, Sanofi, Regeneron, Eli Lilly, Genzyme, Aegerion, Esperion, AstraZeneca, Omthera, Pronova, Vascular Biogenics, Boehringer Ingelheim, Catabasis, AtheroNova, UniQure, Novartis, Merck, Isis Pharmaceuticals, and Kowa; PWS is a member of the international advisory board of Abbott Vascular; CS, AS, SU, JR, SM and HMGG have nothing to declare.

Authors’ contributions
MB designed the study, made the literature search, drafted the manuscript, prepared the final version and submitted the paper. CS designed the study, made the literature search and drafted the manuscript. AS designed the study, made the statistical analysis and corrected the draft of the paper. SU made the literature search. DPM, KKR, JR, PPT, PM, SM, HMG-G, GKH, JJPK and PWS corrected the draft of the paper and prepared the final version of the manuscript. All authors read and approved the final manuscript.
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