Impact of High-dose Statin on Plaque Morphology

Kini AS, Vengrenyuk Y, Shameer K, et al. Intracoronary imaging, cholesterol efflux, and transcriptomes after intensive statin treatment: The YELLOW II study. J Am Coll Cardiol. 2016; DOI: 10.1016/j.jacc.2016.10.029

Past imaging studies suggest statins may impact plauqe biology by reducing atheroma volume and lipid content, and increasing fibrous core cap thickness; high dose statins may have a more potent effect.

YELLOW II study evaluated changes in obstructive plaques looking at fibrous cap thickness, lipid content, changes in gene expression, cholesterol efflux, macrophage migration and HDL functionality.

Results: There was an independent association between fibrous cap thickening and improved cholesterol efflux capacity which could suggest that intensive statin therapy supports plaque stabilization.

The authors note that the observed changes appear to be independent of changes in plaque lipid content or in serum cholesterol. 

Among study limitations, there was no evaluation of important confounders including smoking, alcohol consumption, exercise, diet.

Take-home points: Eight weeks of high-dose rosuvastatin resulted in decreases prevalence of thin-cap fibroatheroma, increased minimal fibrous cap thickness, increased cholesterol efflux, and expression of genes involved in cholesterol metabolism, inflammation, matrix degradation, cholesterol regulation, statin metabolism.