European Radiology

, Volume 20, Issue 12, pp 2824–2833 | Cite as

Influence of statin treatment on coronary atherosclerosis visualised using multidetector computed tomography

  • Hans Hoffmann
  • Katja Frieler
  • Peter Schlattmann
  • Bernd Hamm
  • Marc DeweyEmail author



Coronary angiography using multidetector computed tomography (MDCT) allows non-invasive assessment of non-calcified, calcified and mixed plaques. Progression of coronary plaques may be influenced by statins.


Sixty-three consecutive patients underwent MDCT as a follow-up to their original CT angiography in a retrospective longitudinal study. MDCT was performed by using a voxel size of 0.5 × 0.35 × 0.35 mm3 at two time points 25 ± 3 months apart. Non-calcified, calcified and mixed coronary plaque components were analysed by using volumetric measurement. The influence of statin, low-density lipoprotein (LDL) and risk factors was assessed by using a linear random intercept model for plaque growth.


The volumes of non-calcified, calcified and mixed coronary plaques significantly (P < 0.001) increased from baseline (medians/interquartile ranges = 21/15–39, 7/3–20 and 36/16–69 mm3) to follow-up (29/17–44, 13/6–29 and 41/20–75 mm3). Statins significantly slowed the growth of non-calcified plaques (statin coefficient β = −0.0036, P = 0.01) but did not significantly affect the growth rate of mixed or calcified plaques. The effect of statin treatment on non-calcified plaques remained significant after adjusting for LDL levels and cardiac risk factors.


Quantification using MDCT shows that progression of non-calcified coronary plaques may be slowed by statins.


Coronary plaques Atherosclerosis Coronary vessels Computed tomography Statins 



Dr Dewey has received grant support from GE Healthcare, Bracco, Guerbet, the European Funds for Regional Development (EFRE), the German Heart Foundation/German Foundation of Heart Research, and Toshiba Medical Systems and lecture fees from Toshiba Medical Systems, Guerbet, and Bayer-Schering. He is also a consultant for Guerbet. Dr Dewey offers hands-on courses on cardiac CT ( Dr Hamm has received grant support from GE Healthcare, Schering, Siemens Medical Solutions and Toshiba Medical Systems and lecture fees from Siemens Medical Solutions and Bayer-Schering. Furthermore, there are institutional research agreements with Philips Medical Systems, Siemens Medical Solutions and Toshiba Medical Systems. These funding sources had no role in the collection, analysis and interpretation of the data and in the decision to submit the manuscript for publication.


  1. 1.
    Clouse ME (2006) How useful is computed tomography for screening for coronary artery disease? Noninvasive screening for coronary artery disease with computed tomography is useful. Circulation 113:125–146, discussionPubMedCrossRefGoogle Scholar
  2. 2.
    Leber AW, Knez A, White CW et al (2003) Composition of coronary atherosclerotic plaques in patients with acute myocardial infarction and stable angina pectoris determined by contrast-enhanced multislice computed tomography. Am J Cardiol 91:714–718PubMedCrossRefGoogle Scholar
  3. 3.
    Leber AW, von Ziegler F, Becker A et al (2008) Characteristics of coronary plaques before angiographic progression determined by multi-slice CT. Int J Cardiovasc Imaging 24:423–428PubMedCrossRefGoogle Scholar
  4. 4.
    Schmermund A, Achenbach S, Budde T et al (2006) 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 113:427–437PubMedCrossRefGoogle Scholar
  5. 5.
    Houslay ES, Cowell SJ, Prescott RJ et al (2006) Progressive coronary calcification despite intensive lipid-lowering treatment: a randomised controlled trial. Heart 92:1207–1212PubMedCrossRefGoogle Scholar
  6. 6.
    Raggi P, Davidson M, Callister TQ et al (2005) Aggressive versus moderate lipid-lowering therapy in hypercholesterolemic postmenopausal women: beyond endorsed lipid lowering with EBT scanning (BELLES). Circulation 112:563–571PubMedCrossRefGoogle Scholar
  7. 7.
    4S Group (1994) Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 344:1383–1389Google Scholar
  8. 8.
    NCEP Expert Panel (2001) 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 285:2486–2497Google Scholar
  9. 9.
    Springer I, Dewey M (2008) Comparison of multislice computed tomography with intravascular ultrasound for detection and characterization of coronary artery plaques: a systematic review. Eur J Radiol 71:275–282PubMedCrossRefGoogle Scholar
  10. 10.
    Lehman S, Bamberg M, Schlett C et al (2008) Progression of coronary artery disease as assessed by serial 64-slice contrast enhanced computed tomography. Circulation 118:S_776–S_777Google Scholar
  11. 11.
    Schmid M, Achenbach S, Ropers D et al (2008) Assessment of changes in non-calcified atherosclerotic plaque volume in the left main and left anterior descending coronary arteries over time by 64-slice computed tomography. Am J Cardiol 101:579–584PubMedCrossRefGoogle Scholar
  12. 12.
    Dewey M, Teige F, Schnapauff D et al (2006) Noninvasive detection of coronary artery stenoses with multislice computed tomography or magnetic resonance imaging. Ann Intern Med 145:407–415PubMedGoogle Scholar
  13. 13.
    Hoffmann H, Frieler K, Hamm B, Dewey M (2008) Intra- and interobserver variability in detection and assessment of calcified and noncalcified coronary artery plaques using 64-slice computed tomography: variability in coronary plaque measurement using MSCT. Int J Cardiovasc Imaging 24:735–742PubMedCrossRefGoogle Scholar
  14. 14.
    Dewey M, Hoffmann H, Hamm B (2006) Multislice CT coronary angiography: effect of sublingual nitroglycerine on the diameter of coronary arteries. Rofo 178:600–604PubMedGoogle Scholar
  15. 15.
    Dewey M, Laule M, Krug L et al (2004) Multisegment and halfscan reconstruction of 16-slice computed tomography for detection of coronary artery stenoses. Invest Radiol 39:223–229PubMedCrossRefGoogle Scholar
  16. 16.
    Cademartiri F, La Grutta L, Runza G et al (2007) Influence of convolution filtering on coronary plaque attenuation values: observations in an ex vivo model of multislice computed tomography coronary angiography. Eur Radiol 17:1842–1849PubMedCrossRefGoogle Scholar
  17. 17.
    Achenbach S, Boehmer K, Pflederer T et al (2010) Influence of slice thickness and reconstruction kernel on the computed tomographic attenuation of coronary atherosclerotic plaque. J Cardiovasc Comput Tomogr 4:110–115PubMedCrossRefGoogle Scholar
  18. 18.
    Saur SC, Alkadhi H, Stolzmann P et al (2010) Effect of reader experience on variability, evaluation time and accuracy of coronary plaque detection with computed tomography coronary angiography. Eur Radiol 20:1599–1606PubMedCrossRefGoogle Scholar
  19. 19.
    Pohle K, Achenbach S, Macneill B et al (2007) Characterization of non-calcified coronary atherosclerotic plaque by multi-detector row CT: comparison to IVUS. Atherosclerosis 190:174–180PubMedCrossRefGoogle Scholar
  20. 20.
    Leber AW, Becker A, Knez A et al (2006) Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol 47:672–677PubMedCrossRefGoogle Scholar
  21. 21.
    Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15:827–832PubMedCrossRefGoogle Scholar
  22. 22.
    Mühlenbruch G, Wildberger JE, Koos R et al (2005) Coronary calcium scoring using 16-row multislice computed tomography: nonenhanced versus contrast-enhanced studies in vitro and in vivo. Invest Radiol 40:148–154PubMedCrossRefGoogle Scholar
  23. 23.
    Austen WG, Edwards JE, Frye RL et al (1975) 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 51:5–40PubMedGoogle Scholar
  24. 24.
    Nissen SE, Tuzcu EM, Schoenhagen P et al (2004) Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 291:1071–1080PubMedCrossRefGoogle Scholar
  25. 25.
    Nissen SE, Nicholls SJ, Sipahi I et al (2006) Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial. JAMA 295:1556–1565PubMedCrossRefGoogle Scholar
  26. 26.
    Law MR, Wald NJ, Rudnicka AR (2003) Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 326:1423PubMedCrossRefGoogle Scholar
  27. 27.
    Pinheiro J, Bates D (2000) Mixed-effects models in S and S-PLUS. Springer, New YorkCrossRefGoogle Scholar
  28. 28.
    Calabro P, Yeh ET (2005) The pleiotropic effects of statins. Curr Opin Cardiol 20:541–546PubMedCrossRefGoogle Scholar
  29. 29.
    R Development Core Team (2007) R. A language and environment for statistical computing. R foundation for statistical computing, Vienna Austria.
  30. 30.
    Kawasaki M, Sano K, Okubo M et al (2005) Volumetric quantitative analysis of tissue characteristics of coronary plaques after statin therapy using three-dimensional integrated backscatter intravascular ultrasound. J Am Coll Cardiol 45:1946–1953PubMedCrossRefGoogle Scholar
  31. 31.
    Virmani R, Burke AP, Farb A, Kolodgie FD (2006) Pathology of the vulnerable plaque. J Am Coll Cardiol 47:C13–C18PubMedCrossRefGoogle Scholar
  32. 32.
    Burke AP, Taylor A, Farb A, Malcom GT, Virmani R (2000) Coronary calcification: insights from sudden coronary death victims. Z Kardiol 89(Suppl 2):49–53PubMedCrossRefGoogle Scholar
  33. 33.
    Wexler L, Brundage B, Crouse J et al (1996) Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation 94:1175–1192PubMedGoogle Scholar
  34. 34.
    Rioufol G, Gilard M, Finet G, Ginon I, Boschat J, Andre-Fouet X (2004) Evolution of spontaneous atherosclerotic plaque rupture with medical therapy: long-term follow-up with intravascular ultrasound. Circulation 110:2875–2880PubMedCrossRefGoogle Scholar
  35. 35.
    Wilson K, Gibson N, Willan A, Cook D (2000) Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies. Arch Intern Med 160:939–944PubMedCrossRefGoogle Scholar
  36. 36.
    Lewington S, Clarke R, Qizilbash N, Peto R, Collins R (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913PubMedCrossRefGoogle Scholar
  37. 37.
    UKPDS Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352:837–853Google Scholar
  38. 38.
    Romero-Corral A, Montori VM, Somers VK et al (2006) Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet 368:666–678PubMedCrossRefGoogle Scholar
  39. 39.
    Bamberg F, Dannemann N, Shapiro MD et al (2008) Association between cardiovascular risk profiles and the presence and extent of different types of coronary atherosclerotic plaque as detected by multidetector computed tomography. Arterioscler Thromb Vasc Biol 28:568–574PubMedCrossRefGoogle Scholar
  40. 40.
    Detrano RC, Wong ND, Doherty TM et al (1999) Coronary calcium does not accurately predict near-term future coronary events in high-risk adults. Circulation 99:2633–2638PubMedGoogle Scholar
  41. 41.
    Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. Jama 291:210–215PubMedCrossRefGoogle Scholar
  42. 42.
    Burgstahler C, Reimann A, Beck T et al (2007) 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 42:189–195PubMedCrossRefGoogle Scholar
  43. 43.
    Cademartiri F, Mollet NR, Runza G et al (2005) Influence of intracoronary attenuation on coronary plaque measurements using multislice computed tomography: observations in an ex vivo model of coronary computed tomography angiography. Eur Radiol 15:1426–1431PubMedCrossRefGoogle Scholar
  44. 44.
    Achenbach S, Marwan M, Ropers D et al (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 31:340–346PubMedCrossRefGoogle Scholar
  45. 45.
    Dewey M, Zimmermann E, Deissenrieder F et al (2009) Noninvasive coronary angiography by 320-row CT with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation 120:867–875PubMedCrossRefGoogle Scholar
  46. 46.
    Bruining N, Roelandt JR, Palumbo A et al (2007) Reproducible coronary plaque quantification by multislice computed tomography. Catheter Cardiovasc Interv 69:857–865PubMedCrossRefGoogle Scholar
  47. 47.
    Choi EK, Choi SI, Rivera JJ et al (2008) Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals. J Am Coll Cardiol 52:357–365PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2010

Authors and Affiliations

  • Hans Hoffmann
    • 1
    • 2
  • Katja Frieler
    • 3
    • 4
  • Peter Schlattmann
    • 3
  • Bernd Hamm
    • 1
  • Marc Dewey
    • 1
    • 5
    Email author
  1. 1.Department of RadiologyCharité, Medical School, Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
  2. 2.Department of Cardiology, Angiology, and PulmonologyKlinikum BrandenburgBrandenburg an der HavelGermany
  3. 3.Department of Medical StatisticsCharité, Medical School, Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany
  4. 4.Potsdam Institut für KlimaforschungPotsdamGermany
  5. 5.Department of RadiologyCharité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu BerlinBerlinGermany

Personalised recommendations